The two health care scoops I've had in the last week -- that the Obama administration expects the legislation they sign to cap or otherwise reform the employer deduction and to pursue universality through an individual mandate -- have both, to my frustration, been understood as gotchas. The Obama campaign said one thing -- though in both cases, they hedged during the campaign -- and the Obama administration will end up doing another. But the larger story here is not what Obama said in the campaign. It's what he's signaling to Congress. In 1994, Bill Clinton built himself a brand new health care plan. It wasn't similar to anything proposed in Congress. It didn't look like George Mitchell's health care plan or Jim Cooper's legislation. (It was like something John Garamendi had proposed in California, but few knew about that.) Managed care amidst managed competition was a new theory. A smart theory, maybe, but a new one. Every Congressman had to understand, and then be convinced of, an idea they weren't previously committed to. That meant the process required more time and began with fewer allies. Conversely, Obama is moving into alignment with the preexisting center of the health care reform debate. The individual mandate has conquered the Senate. It is in Ron Wyden's bipartisan Healthy Americans Act. It is in Max Baucus's White Paper. Today, CBO director Doug Elmendorf testified that "near-universal coverage" -- the CBO is more careful than politicians -- "would require mechanisms for pooling risks, subsidies to make health insurance less expensive, and an enforceable mandate." (Read his prepared remarks, which go into much more detail, here). Similarly, reforming the employer tax exemption is widely understood to be not only a crucial source of new money for health reform but an important step forward in rationalizing the health system as a whole. It is, again, in Ron Wyden's bipartisan Healthy Americans Act. It is, again, in Max Baucus's White Paper. And it was, again, mentioned by Doug Elmendorf in his testimony this morning. In fact, it was mentioned by Wyden and Elmendorf at once. "Wouldn't it be possible," Wyden asked, "to generate additional revenue that would be progressive in nature and also serve as a disincentive to inefficient spending by reforming the federal health tax laws?" Elmendorf's reply was one word: "Yes," he said. Obama is signaling support for the congressional consensus. The skeletal health plan outlined in tomorrow's budget has been built to fit the work Congress is already doing on health care reform. As such, it will being with committed allies. It will not lose time defining new concepts to skeptical committee chairs. It will respect and support the existing legislative coalitions It is a strategy aimed at ensuring votes. At passing legislation. At achieving consensus, or as close to it as the Senate can come.
