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Health Reform Ideas in the Primeval Soup
Unformatted Document Text:  34 1965 there were competing policy ideas, but a much smaller and more integrated policy advocacy coalition. Those who developed and advocated the social insurance idea did not have the intense competition of ideas that we find today in the health policy community from various advocacy coalitions. Kingdon argues new ideas don’t suddenly appear, but familiar policy ideas are recombined. This happened with the total Medicare process. Mills combined the idea for a social insurance model hospital financing program for the elderly with a slightly different approach for physician payments, and a medical vendor payment program for the welfare poor. Both Democratic candidates have detailed proposals on their websites, and they have advocated them on the campaign trail. The difference between 2008 and 1964 is that Medicare as a policy idea had a life long before the presidential campaign. Hospital insurance for the aged through Social Security had been a policy idea developed years before and largely a consensus idea in the health policy community. Neither Hillary Clinton’s or Barack Obama’s campaign plan has this type of consensus. And in today’s world the much more fragmented policy community may be incapable of arriving at such a consensus. Some have retrospectively suggested President Bill Clinton would have been more successful by sending Congress a detailed outline of his suggestions rather than a thousand page bill produced by a closed process involving hundreds of people. 82 President Bush’s experience with the Medicare Prescription Drug bill in 2003 may be instructive. He began with a fairly detailed plan, but after initial Congressional resistance from within his own party, he provided a set of principles and allowed the committee leaders to negotiate the details. The Clinton and Obama plans are both fairly general in their description. They are outlines of principle rather than administratively detailed. This is appropriate for campaign documents. They do each combine several of the ideas discussed above. A main point of jostling between them on this issue has been over whether or not the Obama plan will be able to achieve universal coverage. To some extent this is a technical question. Both seek universal coverage as a goal. A summary of the plans of each is provided in the appendix. After a brief categorization of the plans on the basis of conceptual ideas, the paper will conclude with strategic speculation about how the new President might approach deciding on the health policy ideas to recommend to Congress, and thoughts on tactical approaches defining a set of policy ideas with a goal of matching the ideas with an available majority coalition. Clinton and Obama Proposals Both Clinton and Obama offer the goal of universal coverage, and offer many similar policy ideas about how to achieve this goal. Both propose to expand Medicaid and SCHIP. Both propose to establish a Health Insurance Purchasing Cooperative (HIPC) and utilize managed competition ideas about offering consumers a wide range of 82 Johnson-Broder, op. cit; Hacker, Road to Nowhere, op.cit .

Authors: Brasfield, James.
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34
1965 there were competing policy ideas, but a much smaller and more integrated policy
advocacy coalition. Those who developed and advocated the social insurance idea did
not have the intense competition of ideas that we find today in the health policy
community from various advocacy coalitions.
Kingdon argues new ideas don’t suddenly appear, but familiar policy ideas are
recombined. This happened with the total Medicare process. Mills combined the idea for
a social insurance model hospital financing program for the elderly with a slightly
different approach for physician payments, and a medical vendor payment program for
the welfare poor.
Both Democratic candidates have detailed proposals on their websites, and they have
advocated them on the campaign trail. The difference between 2008 and 1964 is that
Medicare as a policy idea had a life long before the presidential campaign. Hospital
insurance for the aged through Social Security had been a policy idea developed years
before and largely a consensus idea in the health policy community.
Neither Hillary Clinton’s or Barack Obama’s campaign plan has this type of consensus.
And in today’s world the much more fragmented policy community may be incapable of
arriving at such a consensus. Some have retrospectively suggested President Bill Clinton
would have been more successful by sending Congress a detailed outline of his
suggestions rather than a thousand page bill produced by a closed process involving
hundreds of people.
82
President Bush’s experience with the Medicare Prescription Drug
bill in 2003 may be instructive. He began with a fairly detailed plan, but after initial
Congressional resistance from within his own party, he provided a set of principles and
allowed the committee leaders to negotiate the details.
The Clinton and Obama plans are both fairly general in their description. They are
outlines of principle rather than administratively detailed. This is appropriate for
campaign documents. They do each combine several of the ideas discussed above. A
main point of jostling between them on this issue has been over whether or not the
Obama plan will be able to achieve universal coverage. To some extent this is a technical
question. Both seek universal coverage as a goal. A summary of the plans of each is
provided in the appendix. After a brief categorization of the plans on the basis of
conceptual ideas, the paper will conclude with strategic speculation about how the new
President might approach deciding on the health policy ideas to recommend to Congress,
and thoughts on tactical approaches defining a set of policy ideas with a goal of matching
the ideas with an available majority coalition.
Clinton and Obama Proposals
Both Clinton and Obama offer the goal of universal coverage, and offer many similar
policy ideas about how to achieve this goal. Both propose to expand Medicaid and
SCHIP. Both propose to establish a Health Insurance Purchasing Cooperative (HIPC)
and utilize managed competition ideas about offering consumers a wide range of
82
Johnson-Broder, op. cit; Hacker, Road to Nowhere, op.cit
.


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