The Fog of Health Care

The Speaker’s Lobby: The Fog of Health Care

By: Chad Pergram, FOX News

25 September 2009

Capitol Hill really isn’t much of a hill. It only rises 88 feet above sea level.

But the visibility here is almost down to zero.

That’s because there’s a thick fog bank shrouding Capitol Hill. It lingers day after day. And the veil never dissipates.

You’ve heard of the “fog of war?” Well, this is the fog of health care.

Generals and military historians often refer to “the fog of war” to describe the ambiguity of a battlefield operation.

Deep in the foxholes and trenches of the health care reform debate, Congressional Democrats and President Obama have a sense of what they want. But their tactics and methods remain ambiguous. No one really knows what a health care reform bill may look like. And to many, even the objectives are obscure.

That’s why in August, those who oppose the Democrats’ approach to fixing health care, were able to seize control of the health care message. Yes, three panels in the House of Representatives approved varying health care reform bills before the summer Congressional recess. But at some point, lawmakers must meld that trio of measures into a single, unified product. In the meantime, opponents sifted through those bills and cherry picked provisions they didn’t like or even embellished things that were nebulous or unclear.

The Congressional fog thickened. But a specialized argot emerged through the soup: Death panels. Coverage for illegal immigrants. Rationing of care. European-style system. Socialized medicine.

A similar fog rolled in when President Clinton made his stab at reforming health care in the mid-1990s.

For instance, Mr. Clinton convened a 500-person health care task force to concoct potential approaches and policy solutions. In fact, the Clinton health care guru, Ira Magaziner, enforced a cone of silence on the task force. He plugged leaks to the press and even to Congressional leaders. Documentation was discouraged so as to not create a paper trail.

On September 22, 1993, President Clinton appeared in the House chamber before a Joint Session of Congress. Health care reform was the touchstone of the young president’s agenda. And Mr. Clinton was confident that his rhetorical flourishes could wow the country and convince a recalcitrant Congress to go along with his plan.

As he took the dais, Mr. Clinton discovered that his health care reform speech wasn’t loaded into the TelePrompTer. Instead, he found the speech he gave to Congress that winter shortly after his inauguration.

Ever quick on his feet, the president asked for a prolonged moment of silence to honor the nearly 50 people who were killed that day aboard AMTRAK in a crash near Mobile, AL. It was the deadliest accident in AMTRAK’s history.

It took some scrambling, but someone corrected the error and jimmied the appropriate speech into the TelePrompTer. Members of Congress and the nationwide TV audience never knew there was a problem. But the nation’s journey into health care reform was already off to an inauspicious start.

“In spite of all the work we’ve done together and all the progress we’ve made, there’s still a lot of people who say it would be an out-right miracle if we passed health care reform,” Mr. Clinton said near the end of his speech.

There are many reasons the Clinton health care reform plan bombed. Some pointed to a policy overreach by the newly-minted president. He garnered only 43 percent of the vote in a three-way race. Perhaps he possessed far from a political mandate to impose such a wide-ranging policy shift. Others placed the blame on then-First Lady Hillary Rodham Clinton. The president charged Mrs. Clinton with leading the health care effort. But others looked to another culprit: specificity.

A month after President Clinton addressed Congress, the White House published a book. “Health Security” read the cover. “The President’s Report to the American People.” The booklet advertised that the forward was written by Hillary Rodham Clinton.

Emblazoned across the top of the publication was mock “health security card.” It resembled a Social Security card. And was the hallmark of Clinton Administration’s labors.

“The card guarantees you a comprehensive package of benefits that can never be taken away,” the book said.

In painstaking detail, 136-page book laid out exactly how the Clinton health care reform effort would work. It explained how certain elements would take effect in 1996. How people could choose their plans and doctors. It described how the measure would tackle the ballooning cost of health care for companies. They even titled chapter three of the book “How the New System Works.”

They tried to market the solution as a fait accompli.

In the end, the concrete particulars created two problems. First, the approach galled the Democratically-controlled Congress. Old bull committee chairs were appalled that they were expected to craft legislation around the parameters of this book and not write their own bills. Secondly, the minutiae handed critics plenty of firepower to shoot down the plan.

It cost too much. It was too bureaucratic. It was too big. And way too complicated.

Mr. Clinton had it right in his speech. It might take an “out-right miracle” to pass health care reform.

The Clinton Administration euthanized its health care reform effort in 1994.

But just like last time, a thick fog now ensconces Capitol Hill. And no one quite knows how to shear through the haze to get a sense of where this is going.

A student of history, President Obama tried to avoid the errors committed by the Clinton Administration. Mr. Obama didn’t dare draft a lengthy booklet detailing every jot and tittle of its legislation. Instead, he left that enterprise to Congressional leaders and specifically, the five House and Senate committee chairmen with jurisdiction over health care.

Four of those panels have crafted health care bills. Lawmakers have bandied about H.R. 3200 for nearly two months now. The Senate Finance Committee is in the throes of writing its version of the health care bill. Each day spurs interminable leadership and caucus meetings about health care. Squadrons of lawmakers shuttle in and out of the Speaker’s Office to confer. Queried by reporters afterwards, lawmakers almost always respond “we’re still working” or “we’re still listening.”

Like NSA wire tappers dialed-in to intercept cell phone calls from al Qaida, reporters and lawmakers alike try to hack through the chatter to detect key phrases. Rather than listening for “Empire State Building” or “Golden Gate Bridge,” they hear “public option” and “surcharge” emerging through the fuzz. Still, most need a colander to sift through the scant details.

And then there are the letter writing campaigns.

The liberal Congressional Black Caucus and Congressional Hispanic Caucus dash off a letter to House Speaker Nancy insisting the bill include a “public option,” a government-run insurance plan. Then the conservative and moderate “Blue Dog” Democrats fire off a missive begging for cost controls. The Progressives follow up with a dispatch demanding certain tax provisions.

Pelosi’s received more letters from House Democrats than Santa Claus gets from naughty children the week after Thanksgiving.

But who wins out? The liberals in the caucus, who insist on the public option? Or the conservative Democrats who want to limit the scope of any health care reform bill.

“We sort of feel like we’re getting mixed messages,” said Rep. Stephanie Herseth Sandlin (D-SD), one of the Blue Dog leaders. Herseth Sandlin said that “there was quite a bit of dismay” at signals Pelosi and other leaders sent that they were forging ahead with a “robust” public option. Such a plan could alienate many if not all of the Blue Dogs. And that could cost the speaker the support she needs from moderates to lug a bill across the finish line.

“Right now, I don’t think they have the votes,” said Herseth Sandlin.

Meantime, many Democrats, especially moderates and conservatives, are growing itchy about the consequences of having to walk the plank to help pass health care reform. Particularly after taking a number of tough votes on the stimulus bill and climate change legislation that was largely unpopular in their districts. Freshmen Democrats feel especially imperiled and worry that Pelosi could twist their arm to vote for a controversial health care reform bill. To some, their electoral future could hinge on the health care vote. But freshman class president Rep. Gerry Connolly (D-VA) says many first-term lawmakers have already taken lots of bullets for the team.

“This has not been a bunch of weak-kneed, lily-livered, tremble-in-the-corner freshmen,” Connolly noted.

The fog stagnates. And even key players at the leadership table concede it’s hard to track the status of the package.

“You should be the head of the caucus,” exclaimed House Democratic Caucus Chairman John Larson (D-CT). “I can’t quite get a feel for where we’re going to go. Every day reveals a new wrinkle or nuance.”

And the wrinkles and nuances continue to emerge as House Democrats take the bill to the legislative crucible to forge a definitive plan. On Thursday, a reporter asked Pelosi when House Democrats would produce a combined bill. Pelosi said she wasn’t sure. But noted, “We are on track.”

Of course on July 23, the speaker said “we will be on schedule to pass this bill before we leave for the August recess.” And on June 6, Pelosi announced she would “have a health care plan on the floor of the House before the end of July.”

Certainly deadlines slip. It’s back-breaking work to write legislation capable of passage. But this is what contributes to the confusion.

Midday Friday, the Democratic brain trust huddled once again in Pelosi’s office. The speaker said that they were “narrowing the number of issues” that still vexed them. And again, declared “We’re on schedule.”

A little later, reporters buttonholed House Energy and Commerce Committee Chairman Henry Waxman (D-CA) as he emerged from the pow-wow. Waxman is one of the speaker’s top lieutenants on reforming health care.

“Have you agreed to anything tentative?” a reporter hollered at Waxman.

The California Democrat paused. Then laughed and went into the House chamber.

And fog of health care hugged the Capitol. At least a little while longer.

-         Chad Pergram covers Congress for FOX News. He’s won an Edward R. Murrow Award and the Joan Barone Award for his reporting on Capitol Hill.

-         The “Speaker’s Lobby” refers to a long, ornate hallway that runs behind the dais in the House Chamber. It’s a place where Members of Congress, aides and journalists often chat during votes on the House floor.