The New York Times has an intriguing piece on the behind the scenes negotiations surrounding health care reform:
Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance.…
The 20 people who regularly attend the meetings on Capitol Hill include lobbyists for AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce… But so far Republican aides have stayed away from the sessions, saying they felt they would be relegated to a secondary role, with no opportunity to set the agenda or choose the outside participants.
Idealists will object to the special interest presence and interpret the meetings as ‘big business writing our health care reform plans'; pragmatists will argue that reform is impossible without negotiating with all of the different stakeholders.
I’d make the case that you can negotiate with the moneyed interests and then use the Presidential bully pulpit to ask for more. So for instance, while the insurance industry would offer everyone insurance if the government mandated coverage, it opposes allowing a new public plan to compete with private insurers and doesn’t want to charge everyone the same price for insurance (community rating).
But negotiations have this way of moving people (hopefully in the right direction). As Families USA’s Ron Pollack recently revealed, the insurance industry is now close to accepting community rating; a public plan, however, is unlikely to win any insurance industry converts.
It’s a give and take, but what’s the alternative? This way, you take what compromises you can get and if you’re still not happy with that consensus, take your case to the American people and convince them of your policy. Ignoring the stakeholders and ramming your plans down their throats is no way to achieve change. We saw that movie in 1993. It didn’t end well.