Quick thought on negotiations

If you read this blog you will know that I have long said the Republican party knows mostly what it is against on health reform and has no positive agenda that is backed up by the political will in Congress to push for it (to do a big health reform you have to be willing to lose the House of Representatives over it). So, they say things like “we need fundamental reform” but we are left in the position of saying well tell us what you think that means? Think of it this way. If the President accepted what the House Republicans passed in the House of Representatives on health reform as part of a fiscal cliff deal, he would be accepting, well nothing. Anyone following wonky health policy blogs has long known that raising the Medicare age is not a fundamental reform except in some symbolic sense, but that is just now seeping into the public consciousness via popular media.

This is a bad situation for the Republican party and the country. Imagine how different the negotiations might be if the House Republicans had passed a comprehensive health reform plan that had been discussed, scored by the CBO, etc. Who knows, maybe they would have done better in the election if they had moved past what they were against.

I still think that a key priority for the second Obama term is putting the Republican Party’s fingerprints on the ACA, both to ensure the political viability of the reform long term, but also because I don’t think we will take the next steps needed without both parties being involved. It is always a danger to negotiate with yourself, and you could easily argue that the ACA was essentially that. However, I think Progressives still have to look for a deal the outline of which still looks something like this.

Republicans actually need a deal far worse than do the Democrats on health reform, because they have no coherent vision backed up with the political will to push it, and desperately need a profound health reform given what they say they want to be true about federal spending. They seem to be the last to know.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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