Policy-ish

Can Health Care Be Overhauled A Piece At A Time?

We doubt President Obama will be turning to Republican Newt Gingrich for political advice anytime soon.

Newt Gingrich i i

hide captionNewt Gingrich argues for incremental health change.

Chip Somodevilla/Getty Images
Newt Gingrich

Newt Gingrich argues for incremental health change.

Chip Somodevilla/Getty Images

But if Obama listens in to NPR's Renee Montagne chat with the former House Speaker on Wednesday's Morning Edition, he'll get a prescription for legislative incrementalism when it comes to health care.

"I don't believe it's intellectually possible to take 18 percent of the economy of the largest economy in the world—life and death for every individual—and in one sweeping bill change all of it," Gingrich says.

People aren't smart enough to write a bill that does everything at once, he says, and a huge piece of legislation (1,300 pages or more) will be larded with "bizarre" goodies that may attract supporters now but cause problems down the road.

Instead, Gingrich argues, the administration should pursue a half-dozen or so smaller bills that target specific changes, such as malpractice reform and fraud in Medicare and Medicaid. (See some of his ideas at the Center for Health Transformation, an outfit Gingrich founded.)

If incrementalism had its time, it's long gone, supporters of an overhaul would argue. They point to myriad problems—from the growing ranks of the uninsured to ballooning spending on care—which are interrelated. Because each piece of the nation's complicated health system affects another, stopping short of comprehensive reform carries its own risks of unintended consequences and failure.

Then there's the political calculation of the Democrats. The town hall meetings last month turned ugly and polls show Americans remain divided.

Data just out from Gallup show 39 percent of Americans would tell their member of Congress to vote against a health-care overhaul bill compared with 37 percent who'd press them to support it. In early August, the numbers showed 35 percent for and 36 percent against.

So the positions are hardening, but the latest data still show 24 percent of people aren't sure what to think. Those are the folks Obama will be trying to bring his way in his speech before Congress Wednesday night.

In April, the New England Journal of Medicine's John Iglehart handicapped the struggle for comprehensive health reform and acknowledged the obstacles facing Democrats' big ambitions. Cue the comparisons to Bill Clinton's failed to remake health care.

So will the administration and key Democrats settle for "a less comprehensive reform plan with more modest benefits than many liberal Democrats favor and tighter controls on costs," Iglehart asked. Maybe. But he wasn't betting on it:

[G]iven the party's current power, public majorities favoring government intervention to ensure coverage, and private interests that recognize the system's unsustainability, the odds remain with Obama and his allies. If their reform affects the entire medical economy, it will represent a paradigm shift away from the incrementalism that has long dominated U.S. health policymaking.

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