Fixing Health Care—the Sequel

"We're at the Thelma and Louise moment ... heading for the cliff." Photo by MGM/Courtesy Everett Collection

Harry and Louise now say they know better.

Their kitchen table skepticism, amplified by a $30 million advertising campaign, helped sink the last significant effort to overhaul the nation’s health care system 15 years ago.

Today, with a few more wrinkles and a new health care debate taking place, actors Harry Johnson and Louise Claire Clark are back, thanks to another alliance of health care partisans. Their message has changed dramatically: “Too many people are falling through the cracks,” Louise says.

President Obama has opened a new health care debate by setting aside $634 billion as a down payment for reforming the way health care is delivered and financed. He told Congress to work out the details.

That’s a sharp contrast with 1993, when the Clinton administration’s plan was developed in secret sessions and then scuttled in a matter of months by an army of lobbyists, polarized lawmakers, and Harry and Louise.

But the landscape has changed. What was a concern in 1993 has reached critical urgency in 2009. Sen. Sheldon Whitehouse, D-R.I., told Obama at a White House “health care summit” of lawmakers and industry leaders last month, “We’re past the Harry and Louise moment. We’re at the Thelma and Louise moment,” he said, referring to the popular 1991 movie. “And we’re heading for the cliff.”

Indeed. Just look at the trends. There are almost 46 million Americans without health insurance (compared with 37 million in 1993) despite the nation’s $2.5 trillion health care spending, up from $912.5 billion in 1993. That breaks down to $8,160 spent per person, compared with $3,468 per person in 1993. We spend nearly twice as much per capita as the rest of the industrialized world, yet have lower life expectancy and higher mortality rates among children. There’s a shortage of nurses and primary care doctors, and emergency rooms are swamped.

No wonder there is unprecedented agreement on the essential need to overhaul our health care system. Even Karen Ignagni, president of America’s Health Insurance Plans, promised to support Obama’s initiative. “You have our commitment to play, to contribute and to help pass health care reform this year,” she said at the health summit.

What a change. After all, her group sponsored the first round of Harry and Louise ads. But don’t underestimate the difficulty of reaching agreement nor the consequences if we fail.

Doctors may say their primary interest is covering the uninsured, but Medicare physicians face a 21 percent pay cut next year. Are insurance companies really willing to extend coverage to people with preexisting conditions as a price for securing the broader customer base that would result from mandatory coverage?

Are hospitals willing to trim costs and scale back treatment? And where will the pharmaceutical industry dig in its heels and flex its muscle? Will it try to block the federal government from negotiating the prices of prescription drugs, or oppose paying higher rebates for Medicare prescriptions, or lobby against plans to fast-track the development of biologic and generic drugs? Are people, including wealthier taxpayers, ready to absorb some of the cost? And how much?

We’re approaching a moment when compromise will be essential. Missing this opportunity would have alarming consequences. But, Harry and Louise notwithstanding, finding common ground is going to be very, very difficult.

Jim Toedtman is editor of AARP Bulletin.