Peter Foley
25 May 2010
Lessons Learned from Health Care Reform
In March, President Obama signed into law the Patient Protection and Affordable Care Act, the culmination of a tireless yearlong campaign funded in part by The Atlantic Philanthropies. Two months later, Atlantic held a discussion in New York City, "The Historic Passage of Health Care Reform in the United States: How Did We Get There and What Lies Ahead?"
This page features video highlights from that event, as well as a forum with ten leading voices from the health care campaign answering the question, "What is the single biggest lesson learned from health care?" In the videos and the forum responses, these ten reform advocates share their views on how the victory was achieved – and what challenges lie ahead. We welcome your comments as well.
 |
 |
| How It Happened | What Was Won |
|
|
|
| Will They Get It Right? | The Politics of Reform |
Forum: What Is the Single Biggest Lesson Learned from Health Care Reform?
- Josefina Alvarado, Elev8 Oakland/CEO Safe Passages
- Deepak Bhargava, Executive Director, Center for Community Change
- E.J. Dionne, Columnist, Washington Post
- Judy Feder, Professor of Public Policy at Georgetown University, Senior Fellow at Center for American Progress
- LeeAnn Hall, Executive Director, Northwest Federation of Community Organizations
- Richard Kirsch, National Campaign Manager, Health Care for America NOW!
- Bruce Lesley, President, First Focus
- Debra Ness, President, National Partnership for Women and Families
- John Rother, Executive Vice-President of Policy and Strategy, AARP
- Lynice R. Williams, Executive Director, North Carolina Fair Share
Josefina Alvarado, Elev8 Oakland/CEO Safe Passages
Our society cannot be confused about the need for health care reform or social justice, which is really at the core of the health care debate. The national dialogue we are experiencing reinforces the need to build relationships between government, health care providers and families living in all communities. These relationships are critical if we are to build a true system of universal health care where access is not dictated by socio-economic status, race, gender, age or immigration status. We cannot afford to leave large segments of our population, like the undocumented, out of our policy debates or reform efforts and believe that we can achieve universal access. Health care reform, however, opens up possibilities that did not exist before and provides us on the local level with hope that change can happen at the federal level. Health care reform also reminds us how much more work has to be done.
I would be remiss not to mention that Elev8 Oakland is thrilled with the passage of health care reform. It is an understatement to say that it was an epic battle. While there are many lessons learned from the health care debate, the most critical one for Elev8 Oakland is the importance of communication and relationships. There is a deep need for politicians and policymakers to communicate with the consumers and families living in the communities. Honest communication builds trust between politicians, health providers, families and consumers. The lack of honest communication confused many issues in the health care debate and fueled the distrust of people in our communities. Confusion caused many good people to doubt the need to take action despite the savage inequities experienced everyday related to health care access. Miscommunication cannot be the wedge between action and inaction in our pursuit of social justice.
Deepak Bhargava, Executive Director, Center for Community Change
The power of organizing is perhaps the single most important lesson learned from the health care reform debate. Grassroots organizing brought health care reform into reality, just as town hall protests and local opposition on the other side nearly killed the bill.
When the history of health care reform is written, the consensus will be that stirring speeches and the skillful management of the legislative process did not secure this victory. The power to win came from an organized base of grassroots advocates all across the nation who persisted in their demand to make basic improvements to our health care system.
Congressman John Boccieri (Democrat from Ohio) – one of the key switches from “no” to “yes” in the final days before the House vote – told the press that it wasn’t the President, nor national voices, that explained his decision. It was the voices of constituents, especially people without insurance, who told their stories and brought him around. This is the story of health care reform, all over the country.
Organizing helped put a human face on the health care debate. Last summer, community organizations helped collect stories about the rural health care crisis at state and county fairs around the country. These personal accounts were invaluable in discussing the bill with legislators from conservative rural districts. In the final push this spring, we brought dozens of survivors of insurance industry abuses to Washington for a Congressional briefing. Marcelas Owens, the 11 year old who stood by the President when he signed the health care bill, was part of this health care survivors project. Marcelas had lost his mother to pulmonary hypertension because she lacked health insurance. The Northwest Federation of Community Organizations, a close ally with the Center for Community Change in the health care campaign, identified him.
The power of organizing was also apparent in the district-level advocacy that helped build the case for health care reform in many swing districts, including those in Ohio, Tennessee, Virginia, North Carolina, and elsewhere. It was a textbook combination of grassroots pressure through phone calls, emails and letters; “inside” pressure from local notables like civil rights leaders and state legislators; a communications strategy that used both traditional media and the blogosphere; and direct action when necessary. Media myths to the contrary, pro-reform forces turned out many more people to the infamous town halls than the tea-baggers – and this was key to victory.
In some ways, we lost the media narrative about health care reform, and were not helped by the poor tactical decisions resulting in protracted, de-energizing negotiations among the so-called “gang of six” in the Senate Finance Committee. We overcame those weaknesses by winning the district-by-district ground war, and that is a statement to the power of grassroots organizing.
E.J. Dionne, Columnist, The Washington Post
Ten years ago, at the age of seven, my son started playing summer baseball and was blessed with a spectacular coach. He was, as it happens, a physics professor who had a great understanding of the game, but even more importantly, understood kids, and life. To this day, everyone in our family remembers his refrain to his team when things went wrong. You strike out with the bases loaded. What do you do? Keep coming at them! You drop a fly ball and let two runs in. What do you do? Keep coming at them! And on it went. There are some days when I think of that slogan and it keeps me going, too.
And that was the essential thing that happened on the health care bill. There were many points – notably after Scott Brown’s victory in Massachusetts – when supporters of comprehensive health care reform might have given up. That would have been a disastrous mistake, both politically and substantively. There was no turning back, and supporters of reform had no choice but to keep coming at them.
This slogan applied not simply to the years 2009 and 2010, but to the much longer struggle. This bill passed in part because proponents learned from past failures, worked for years to achieve consensus on an approach that could command majority support in Congress and eventually win backing in the country.
President Obama learned the lesson of my son’s baseball coach, too. He began his administration hoping to achieve concord across party lines. But when that proved impossible, he jettisoned the happy talk and came out fighting. If bipartisanship is more fashionable than partisanship, partisanship with a purpose is infinitely preferable to paralysis.
The final bill is not what everyone had hoped for – but then the original Social Security Act wasn’t, either. Comprehensive reform is hard. It tends to come in steps. But getting a new system in place has already fundamentally altered the health care debate. There is no going back now, as even opponents of the bill acknowledge. Their slogan, after all, is Repeal and Replace, not just Repeal. In democratic politics, there are no final victories. But some victories transform the landscape, and precisely because it was the product of such a long struggle, I believe passage of health reform is one of them.
Judy Feder, Professor of Public Policy at Georgetown University, Senior Fellow at Center for American Progress
After participating in the Clinton Administration's unsuccessful effort to pass health reform, I'd concluded we'd only be able to make reform happen when we'd convinced voters - most of whom have health insurance - that they had more to gain than to lose from covering everyone else. But, despite our best efforts, even this campaign has yet to overcome opponents' efforts to scare voters into believing that reform puts them at risk.
The success of this campaign taught me a different lesson about what it takes to get major change "over the top." Even with less-than-fully-supportive public opinion, we helped convince anxious members of Congress that the risk they faced was failing to pass health reform, not passing it; to let them know they simply couldn't afford to vote for the status quo. Without a campaign that forced even change-oriented members of Congress - those who count on us for support - to keep their eyes on the prize, it's hard to believe we'd be celebrating enactment of reform today.
The health reform campaign - with its strengths as well as its limitations - showed us that keeping our elected officials committed takes all the tools in our arsenal, working together, all the time. We used research to expose the "ugly underbelly" of the status quo; persistent communications efforts to make its most egregious failures front page news; aggressive advocacy to show members of Congress that reform addressed those failures; and effective political engagement to let members of Congress know that they could count on us for electoral support, but only if we could count on them for enacting reform.
The lesson from this health reform campaign is that if we stick together and bring to bear all our resources we can sometimes make change happen. If we don't, we haven't got a chance.
LeeAnn Hall, Executive Director, Northwest Federation of Community Organizations
Race matters, and the rhetoric around what we want needs to align with our vision for change. This played out during the health care debate, including in an early and crucial discussion of framing. Reflecting on the polls, coalition strategists came up with the phrase "health care for all Americans" to convey the basic principle underlying our campaign. There was a lively internal debate that resulted in changing the principle to "health care for everyone in America," with the goal of making the language more inclusive of not only immigrants but also people of color more generally.
Clarifying this principle reflected our real core values. It resonated in communities where we were organizing, motivating community members and organizers alike. And it created a framework for pursuing inclusive policy components in the reform package.
Ultimately, this early agreement on principle yielded benefits over the course of the campaign. As the legislative process moved forward, we won inclusion of provisions to address racial disparities in health, such as support for community clinics and permanent reauthorization of the Indian Health Care Improvement Act. In one other key area - immigrant inclusion - we were not successful. But the coalition held together because from the very start the coalition had agreed on the importance of inclusion.
That early conversation about racial justice in health allowed us to build a big tent for our coalition. It brought key organizations to the table and broadened our organizing in the field. As a result, we were able to move forward as a coalition, with different people working on different aspects of the agenda, and win a historic victory. From this victory, we've learned that it both matters what we say and that we need to have this conversation at the outset.
Richard Kirsch, National Campaign Manager, Health Care for America NOW!
If you believed the headlines, health care reform would be dead. The press announced its demise over and over again, buried once and for all after Scott Brown’s election on January 19th. So how did reform become law? It certainly wasn’t because the polls were showing that the Obama health reform proposal was overwhelmingly popular. In fact, polls showed the public evenly divided, with strong opposition in swing states and districts. What did the press and conventional wisdom miss? History and a grassroots campaign around the country that made members of Congress feel that history in their bones.
It’s not just a rhetorical flourish that President Obama kept pointing out that presidents have been trying to make health care a right back to Teddy Roosevelt. And it wasn’t simply window dressing when Senate Majority Leader Harry Reid announced the introduction of his reform bill with a sparkling quote extolling reform delivered by President Truman 45 years earlier, to the day. The Democratic leadership deeply felt the historical and moral imperative of passing reform and really believed it was worth the political risk.
This historical view was at the heart of HCAN’s strategy, much of which aimed at building and reinforcing the broader perspective by bringing the people, their stories and voices to members of Congress. Starting with garnering the signatures of 140 members of Congress, including the President Elect, for HCAN’s principles by Election Day in 2008, through continuous public and private meetings and events with members of Congress in their home states and districts, rescuing Democrats in the August town halls by repeatedly turning out more people than the tea partiers, to marches to Washington and late-night vigils on the night before the final vote, HCAN’s core strategy was to demonstrate in the most personal terms that when members of Congress voted for reform that they had the backing of people whose lives bore witness that voting to turn health care from a privilege to a right would be a legacy that transcended politics.
Bruce Lesley, President, First Focus
Our biggest lessons learned were to make no assumptions and never give up.
First, we assumed health reform would undoubtedly help improve the health of our nation's children and were thrilled to move into the battle to enact health reform. However, just weeks after passing the reauthorization of the Children's Health Insurance Program (CHIP), our advocacy was initially derailed when the children's community discovered that, in part due to a combination of politically powerful advocates pushing for CHIP's repeal, Congress was proposing to end CHIP as part of health reform. This was initially proposed despite the fact that would have left 4-5 million low-income children worse off than under current law.
Second, the coalition we had counted on to pass CHIP reauthorization surprisingly dissipated, as a number of former strong allies of CHIP began to advocate for its repeal or were agnostic about its continuation due to their stated support of the "greater good" of passing health reform.
Although more powerful and well-funded interests made initial progress on pushing for CHIP's repeal, the children’s and religious communities rallied to form a new coalition to not only successfully protect CHIP but to also extend the program. We rejected the false trade-off that kids might have to be traded away to get health reform, and successfully created a newly-formed strong coalition by engaging cross-sector constituencies and community-based partners -- many for the first time.
In the end, by never succumbing to what some felt was inevitable, we successfully fulfilled the original vision that children, who comprise one-quarter of our population, must also benefit from health reform.
In fact, we already see major progress, as pre-existing condition exclusions and lifetime caps that previously were imposed upon vulnerable children are being eliminated. Furthermore, health reform, when fully implemented, will nearly reach the goal of universal coverage for our nation's children.
Debra Ness, President, National Partnership for Women and Families
Every great accomplishment is, at first, impossible. To make real progress we have to dig in, keep fighting, keep our eyes on the prize, and prove the naysayers wrong. That’s what it took to pass health care reform. There were so many times when victory seemed out of reach, but we kept fighting because we knew what was at stake. We had to make some painful compromises along the way, and we must keep working to improve on this foundation to ensure that access to quality, affordable health care becomes a reality for all. But this was a huge victory, and it would not have been possible without the vision, conviction and perseverance to do what at many points seemed “impossible”.
The same will be true for implementation. The task ahead may be even bigger, because to make reform really work, we need to do nothing less than transform the way our health care system delivers care. There are many who say it can't be done, that you can't improve quality and get costs under control. But that's exactly what we need to do -- and we can do it if we apply the lessons of the fight for reform, and refuse to give up until we realize the law’s promise.
We’ve put the building blocks in place, and now we need to redouble our efforts to shape a system that provides better quality, better coordinated, comprehensive care for those who need it most, like vulnerable older adults with multiple chronic conditions. The work ahead is to deliver on the promise of better care. It won’t be easy, but I am confident that we'll get there – learning even more lessons along the way.
John Rother, Executive Vice-President of Policy and Strategy, AARP
There are literally hundreds of lessons to gain from the multiyear effort to enact meaningful health reform. The single greatest lesson is the need for the President to communicate to the Congress and the country both the need for action and the goals of the reform effort. Without the messages about the dangers of the status quo and clearly stated reform goals from the President, nothing would have been possible. These messages were developed during the campaign and refined throughout the first year of the Administration, so the public and members of Congress understood that this was the top priority for the new Administration, and understood why bold action was necessary. It didn’t mean that everyone agreed with the program, but just enough did to finally enact historic legislation.
Lynice R. Williams, Executive Director, North Carolina Fair Share
The greatest single lesson learned from health care reform for me was the importance of grassroots organizing. Here in North Carolina, a conservative state, a strong coalition “NC Health Care for America Now!” (part of the National Health Care for America Now Coalition) was able to build a base of diverse partners with constituents impacted by the lack of adequate health insurance and access to health care. These partners kept a vigilant press on several fronts through campaign deliverables of mass community education, health care rallies, press events, statewide door to door canvassing, and consistent visits to key NC members of Congress in state and in Washington D.C., with testimony from people with their own stories for the need of reform. These and more organizing efforts made our US Senator Kay Hagan a supporter for reform. We didn’t win our entire North Carolina delegation's vote for the landmark legislation, but the coalition efforts were successful. It has made all partners ready for the long haul of implementation and our continued work together.
What strikes me more is in efforts to win on national health care reform, one thing became clear in our public discourse about health care reform: As a nation, we had never made a national legislative or moral commitment to guarantee health care for all. Is it any wonder, then, that we still fight bitterly over whether we should increase access, reduce costs, add or reduce benefits in public programs, increase income eligibility for public assistance, institute cost controls, improve delivery, decrease the deficit, and more? The ongoing debate over such details demonstrates that it is not a lack of policy creativity or resources to move us forward, but the absence of a moral vision accompanied with political will to use our abundant resources in service to the common good. While we have legislated health care for most of us, we are not yet united around a moral commitment to health care for all. There are still almost 15 million people who will not be covered by this legislation so our work for implementation and grassroots organizing continues. Onward!
We welcome your views. What’s the biggest lesson learned in your view? How do these lessons apply to other advocacy campaigns?
Why not reform?
Why didn't we attempt comprehensive healthcare reform first, rather than immediately run to the Obama-care option? If we can get government healthcare through, we should have been able to enact strategic, broad reforms that took care of many of these issues without adding trillions to the national debt, risking healthcare rationing as seen in other countries with government-run healthcare, and violating the constitution?
Adding trillions to the national debt places a huge and unfair burden on future generations- how's that for social in-justice?
Medicare Payments to Doctors& Doctors Refusing Medicare Patients
The historic new health care and insurance law is already being sabotaged in its implementation by some doctors, hospitals, and other health care providers who refuse to treat patients covered by Medicare, Medicaid, and TRICARE.
Claiming that reimbursements are too small, more and more health care providers are selfishly refusing to provide medical services to patients covered by these health insurance plans.
The greater legal social contract in America gives benefits to both medical patients (through Medicare, Medicaid, and TRICARE) and to medical providers (through the tax code and insurance payments). If some providers refuse medical care benefits to these patients, those providers should lose their tax benefits. That is simple social justice.
The legislative solution: Congress should amend the pending multi-billion dollar per year “doc fix” legislation (reinstating the Medicare Physician Payment Reform Act of 2009) to make it more costly for health care providers to refuse these patients than to treat them. The amendment should refuse Government-provided tax subsidies to any individual or group of physicians, hospitals, corporations, and other health care providers if those providers refuse to treat patients covered by Medicare, Medicaid, and TRICARE.
--A. Medicare Patient
The morals are the message.
The biggest lesson learned for me was about communication. I appreciate Judy's comment that it takes all the tools in the arsenal, but I think we saw really great grassroots organizers essentially strongarm congress into reform (which I loved to see) in spite of a messaging and communications infrastructure that lurched from one message to the next. I was disappointed that The White House never made a moral case for reform and I worry that we passed this bill without the country having learned anything, or having the only lessons learned be about politics and not the plight of the uninsured.
Public Option
What about the public option!? I watched the video about the politics of reform and realize its a drag, but are we going straight to implementation without working for key fixes? Is there momentum and support for a public option campaign?
OFA & The Grassroots Infrastructure
This is a really great set of lessons learned. I did volunteer work through Organizing for America, but the challenge for OFA is their coziness with The White House. I think that groups like HCAN were smart to work with The White House but also hold out for key changes and retain some independence. I'd be curious your thoughts on how the DNC, OFA and what I call the "institutional" grassroots performed on the campaign. So much of the Obama-mentum from 2008 was channeled into those outfits, but I feel like it was the work of more "outsider" groups like these listed here that got health care done.
Post new comment