History Shows Reform Efforts Hard To Kill

July 15-- Oklahoma leaders and those of a few other states continue to fiercely resist federal health-care reform, but that's not the case everywhere.

While the tenor of talk around here would suggest "Obamacare" is the most despised piece of legislation ever drafted, some states -- and their stakeholders -- are eager to forge ahead with reform. In fact, some are even well along in implementing reform measures.

What's more, there's evidence that significant numbers of Americans support provisions of the reform act -- and equally large numbers of Americans just want the arguing and rancor to end.

So, is repeal of Obamacare really the direction we're heading in this country?

Last week, the House voted again -- more than 30 votes to date have been taken along these lines -- to repeal the law, known as the Affordable Care Act. Because the repeal has no chance of advancing in the Senate, it is seen as little more than political posturing, an opportunity to generate campaign fodder.

Even Republican leaders are acknowledging the repeal is no easy proposition. The GOP is going to need a lot of help in November's elections to be able to bring repeal about.

But even if Republicans do get everything they need to move forward with repeal, they still must face the fact that some reforms already are helping huge numbers of Americans. How do they make the case for taking away such precious and welcome benefits?

Past is prologue

A century ago, the U.S. headed down the path toward guaranteed health care, and it's been a rough and rocky road ever since. It's instructive to take a look back.

Most Americans are aware that Medicare, the government-backed health-care program for the elderly, was signed into law by President Lyndon Johnson in 1965. But they may not be aware that "social insurance," including health insurance, was endorsed as far back as 1912 -- in the platform of the Progressive Party, whose candidate was Theodore Roosevelt.

Even the notion of compulsory participation is quite old, dating back to 1798. The U.S. government set up a Marine Hospital Service and required the owners of merchant ships to contribute 20 cents a month per seaman for a "sickness fund," according to a history of Social Security and health insurance initiatives in the U.S.

When Johnson signed the Medicare bill on July 30, 1965, he made sure former President Harry Truman was there, to pay tribute to the former chief executive who had taken on the hard fight to add health insurance to Social Security benefits 20 years earlier. According to the history, Johnson observed at the signing: "We marvel not simply at the passage of this bill but that it took so many years to pass it."

The chronology of national health insurance efforts is too extensive to summarize here. In a nutshell, suffice to say there were dozens of reports, pieces of legislation, committees, surveys and the like that came and went during the decades before President Franklin D. Roosevelt managed to get national health insurance taken seriously in the 1940s. After his death, Truman took up the cause.

Needless to say, the idea was controversial. After initially favoring some form of health insurance, the American Medical Association later reversed its stance, and took up a decades-long crusade against these measures.

But in the end, after more than a half-century of debate and attempts, Americans got their Medicare, and in the half-century that's followed passage, it has become one of the most popular and entrenched government programs ever -- second perhaps only to Social Security.

Will history repeat?

Are we looking at another half-century of debate and legislation when it comes to this next phase of American health-care reform? Could be. Medicare and its companion program for certain populations, Medicaid, have been tinkered with and even dramatically altered in the decades since they came into existence. President Obama has signaled his willingness to work with Republicans on improving the Affordable Care Act. Given the way these things have played out in the past, it's a good guess that's where we headed.

But for now, lots of folks already are up to speed on implementing the law. According to a June report prepared by PricewaterhouseCoopers' Health Research Institute, "leading health sector participants" are well along in "devising new ways to conduct business and move ahead of the competition in the face of impending deadlines" under the ACA.

The report, "Implications of the U.S. Supreme Court Ruling on Health Care," said the incentives for collaboration in the act "are quickening the convergence of hospitals, insurers, drug makers, physicians and technology companies."

"Despite the political uncertainty, private-sector initiatives, accentuated and accelerated by the health reform law, are moving forward," said Kelly Barnes, leaders of PwC's U.S. Health Industries Group.

"The pressure for innovative ways to provider higher quality, more affordable health care continues. Health care organizations that have been sitting on the sidelines will now have to get in the game and play catch-up."

The report found that 14 states plus the District of Columbia "have made significant progress toward reform," while 19 states have made "moderate" progress. The remaining 17 states have done less toward implementation and may, the consultants believe, end up having to collaborate with other states to catch up.

A political reality?

All the activity detailed by the report suggests to some analysts and observers that health care reform is fast becoming a de facto reality on the political landscape, thanks in large part to the momentum that has built since the reform act was passed two years ago.

What about all of those everyday Americans on whose behalf our leadership is going through such machinations? What do we think ought to happen, or not happen? Turns out we might not be as worked up as some leaders would have us believe. Some recent polling shows about half the country didn't even know the Supreme Court had ruled on the law. And other polling consistently shows close to half the country supports the law's provisions while about half are against the law.

It's almost a certainty that health-care reform will occur out of necessity. Its final form has yet to be determined with certainty, but there's no denying this train has left the station and is going to be hard to stop.

Janet Pearson 918-581-8328

janet.pearson@tulsaworld.com

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