, Newburyport, MA


March 29, 2014

Shribman: Learning from Obamacare


“Could it be more clear? Less complicated? Absolutely,” says Diane Holder, president of the UPMC Health Plan in Pittsburgh. “Is it directionally correct? Yes. Will it ultimately help a sufficient number of people? I think so.”

-- Keep the process transparent.

Obamacare was created in an atmosphere far more open than the environment that produced the Hillary Clinton health care plan, which is one reason the Obama proposal is law today and the Clinton plan is not.

But the Obama team allowed a dangerous narrative to be created, the notion that the system it was creating was needlessly complicated. The truth is that the system is complicated not because of a government takeover, but because the administration left in place so many elements of the existing system.

“The irony of it all is that the reason it’s so complex is that the administration tried to preserve as much as possible from the current system,” says Stuart Altman, a Brandeis economist specializing in health policy. “The result was a system even more complex.”

-- Sell to the middle, not to the extremes.

Of all the guidelines that emerge from this episode, this is the one the administration has mastered best. The liberals who demanded a single-payer system and the conservatives who were going to oppose on principle, or out of habit, anything the president proposed are stewing. But at the end of the day -- or in this case, at the end of this month -- the president has a health care overhaul worthy of the name, if not of everyone’s best hopes.

It would have been better had the software worked, it would have been better if the national consensus were broader, it would have been better had bureaucratic delay not been piled upon bureaucratic delay. But his critics on both sides of the argument are going to have to concede that history will attach health care overhaul to Barack Obama’s name. That may be the biggest lesson of all.

North Shore native and Pulitzer Prize winner David M. Shribman is executive editor of the Pittsburgh Post-Gazette.

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