Rendell's Health Care Plan

Among the presidential candidates, Gov. Bill Richardson of New Mexico is one of the few that has so far categorically ruled out tax increases as part of his path to universal health care insurance. His plan: cut costs and use the savings to get everyone into the system.

State officials have a pretty good sense of what it takes to get something done in a capital. The lobbying forces that weigh in at the state level are the same ones that weigh in at the national level. Learning how to confront, manipulate and compromise with those forces is central to the job description of a president who is going to get things done.

One of the major choices voters have next year is whether they want an "outsider" from one of the nation's statehouses -- don't forget that four of the last five presidents were former governors -- or a Washington insider who is inevitably compromised by long-standing ties to major lobbying organizations in the nation's capital. If you choose the former, then Richardson becomes a logical choice. Given his international experience (he's negotiated with many of the belligerants on earth), energy expertise and the fact that he's Hispanic (the other "first ever [blank] elected president!] in this race), it's rather surprising that the nation's press hasn't given his dark horse candidacy more attention.

That said, his approach to health care is the tough road. Kevin Sack's excellent article in today's New York Times on Gov. Ed Rendell's efforts to enact universal health care in Pennsylvania shows why. An experienced local (former mayor of Philadelphia) and state politician, he is trying to get everyone covered by asking all the special interests in the system -- the insurance companies, the doctors, the hospitals, the small businesses who don't provide coverage for their employees -- to give up a little economic ground. Not surprisingly, he's run into a buzzsaw of opposition. Here's the relevant paragraphs:

Hospitals are lobbying against his proposals to regulate expenditures for new construction and equipment and to cut off reimbursement payments when patient stays are extended because of medical mistakes and preventable infections. Doctors do not like his proposal to give more responsibility to physicians’ assistants and nurse midwives.

Small-business owners are protesting his call for a “fair share assessment” — a 3 percent payroll tax on employers who do not offer insurance, with the proceeds dedicated to covering the uninsured. And insurers are working to defeat proposals that would prohibit consideration of preexisting medical conditions in rate-setting and require that at least 85 percent of premiums be spent on health care costs as opposed to administrative overhead.

In the wake of actions by Massachusetts and California to enact universal health care plans, Rendell thought his proposal would be a slam dunk. He now gives it no better than a 50-50 chance of success. The denouement of this struggle bears watching. More than the other large states that have passed deeply flawed universal health care plans, it has brought the major lobbying forces into play because it curbs some of their power -- something any successful plan will have to do.

If Rendell wins, it will raise the stakes in the health care debate that will dominate next year's presidential race. And it will improve the chances of the governors in both party's races who argue that they're the ones that know how to get things done in a capital.