Rep. Mike Rogers (R-Mich.); Julia Lynch, Department of Political Science, University of Pennsylvania; Ceci Connolly, Staff Writer, The Washington Post; Don Wolfensberger, Director, Congress Project (Moderator)

Congressman Mike Rogers (R-Mich.), a member of the House Energy and Commerce Committee's Health Subcommittee, told a Wilson Center health care seminar audience on September 21 that in six months Congress could find agreement on health care reforms that would result in 75 percent of all currently uninsured children and 20 million uninsured adults being covered (out of the president's latest estimate of 30 million uninsured Americans). This could be done, Rogers said, by expanding outreach for existing Medicaid program for the poor and the State Children's Health Program (S-CHIP), and getting more people to open health savings accounts. "We can all agree on things we should do," Rogers said, but it doesn't necessarily require new government bureaucracies that will end-up limiting care.

Rogers also advocated repealing the law that now prevents people from buying insurance across state lines, citing the example of Blue Cross premiums costing $300 a month less in Indiana than in his home state of Michigan. Asked whether any of the pending plans in Congress are likely to pass, Rogers said they were all in trouble. He had hoped that the president would propose something new in his address to Congress that could bring the parties together, but that did not happen.

Washington Post health reporter Ceci Connolly noted that the Obama Administration has been making "a very conscious effort to avoid not making the same mistakes" as the Clinton Administration's abortive health care reform efforts in 1993-94. In that instance, she said, they used 500 policy experts to write a 1,300 page bill in secret. This time, the Obama Administration started by neutralizing the usual enemies of reform—the insurance industry, drug makers, and physicians—by putting various deals on the table and making trade-offs. "For the most part, this has worked." Moreover, the president is not attempting to dictate the details of the legislation and is letting Congress work its will. Connolly said the president has been relying on the Lyndon Johnson model in attempting to push a bill through Congress by building relationships, member-by-member: "Constant stroking is very important."

What the Administration did not take into account, she said, was that there would still be "a large ideological and political opposition building against any changes. The White House was caught off guard by this." Moreover, they didn't consider that the Senate might be a problem. And yet the bipartisan "Gang of Six" has held things up for months now with its discussions behind closed doors, with no bipartisan product to show for it. "What could they possibly have been talking about for those hundreds of hours," Connolly wondered. She said she learned that senators just like to tell each other stories about their earlier careers. Connolly concluded that a lot of work still needs to be done in eventually melding the three House reported bills and the two Senate measures. Big questions remain on such issues as financing the costs of the new arrangements. The final bills will be written by the majority party leadership, in close consultation with the relevant committee chairmen and the conservative Blue Dog Coalition, she said, and will likely look considerably different from the reported versions.

Julia Lynch, assistant professor of political science at the University of Pennsylvania, presented a paper based on survey research she had conducted about public attitudes toward a government run health insurance program. She found that contrary to conventional wisdom, people do not necessarily base their judgments on self-interest, but rather on moral judgments about fairness in dealing with inequalities in health care. Yet she noted that the president relied very little in his recent speech to a joint session on the moral imperatives of change and more on appealing to people's self-interests. According to Lynch's research, once people are exposed to various scenarios of inequalities in health care, they are much more likely to support a government program to deal with these problems. People's "moral evaluations affect their policy preferences," she said, and "may also motivate people to get out in the streets and do something about it."

By Don Wolfensberger