Early in President Obama’s address to the joint session of Congress yesterday, he underscored how important reform was to those intimately involved in health care:
“Our overall efforts have been supported by an unprecedented coalition…even drug companies, many of whom opposed reform in the past.”
His point was clear. The health care system was fraying so dramatically that allstakeholders — even big pharma — had to be in the reform camp.
He didn’t have to emphasize drugmakers. He could have spoken about the support of the American Medical Association, which is in favor of current legislation, or even insurers, who have largely sat on their hands during the debate despite being routinely vilified. One of the elements that makes the reform effort of 2009 different from attempts in 1993 or 1965 or 1952 is that the big interest groups, for the first time ever, are on the side of change.
Given that these groups are credited with deep-sixing nearly every effort at comprehensive health reform over the past century, it would stand to reason that reform bills should skate through Congress without such hurdles. After all, big business isn’t throwing millions of dollars of TV ads to undercut the president this time around.
And yet the talking heads after the speech made clear that reform prospects remain precarious and that this is a numbers game now for the president. Can he hold Democratic votes? Can he nab a Republican senator? Two?
So if the big interest groups aren’t the ones making this a nail-biter, who is? As it turns out, it’s a collection of a thousand (or million) politically driven interest groups, many of them using media that didn’t exist 18 years ago to get out their message. Some of it is the Internet, which has made both pontificating and organizing easier than ever, some of it is the explosion of 24-hour cable news. And some of it is the use of technology to make all sorts of old tools, from direct mail to canvassing, smarter and more effective.
The point here isn’t to decry the echo-chamber effect in which we only hear the news we want to hear, from ideologically “safe” sources. (Though that it worth decrying.) It’s to illustrate how good at transmitting messages the ideological warriors on both sides of the health issue (and, indeed, any political issue) have become, especially in contrast to health companies, who are just now dipping their toes in social media waters. In 1993, Harry and Louise and a boatload of national airtime could effectively steer the debate. Now, shaping the discussion is far more complex. Opponents of reform understand that. The unresolved questions are whether the health care industry — patients, doctors, executives, researchers and scientists — understand the new reality, and whether
they can adapt to it quickly enough to salvage reform.