Health Reform in a Changed Political and Policy Environment

Several pieces of information and events have recently made me appreciate how the policy and political environment for health reform will be very different in 2009 from what we’ve seen before.

First was an article in the November 22nd issue of National Journal, (“The New Power Landscape”), which describes how the process for influencing legislation (a.k.a. lobbying) will be different in the coming years: “On the way in is a more collaborative approach that relies on identifying allies and building coalitions with other interest groups, as well as grassroots organizing.”  The article specifically posits that the importance of access to influential people, (i.e. elected officials and key staff), will be  replaced by “groups’ ability to make a policy argument that meshes with Obama’s agenda and that of congressional Democrats.  The organizations must also demonstrate grassroots support and offer in depth research on their priorities…”

This situation is consistent with the principles that guided the Obama campaign, which did an outstanding job in grassroots organizing for both their field operations and GOTV efforts, as well as for their record-smashing fundraising.  And apparently that organizing effort is not going to waste.  This weekend there were hundreds, (and perhaps thousands), of “house parties” across the country, organized by campaign volunteers for them to discuss with their compatriots how to keep their efforts alive and directed toward other actions for change – including civic volunteering, and local and national legislative efforts.  These house parties were the second thing that made me realize the environment for health reform would be different.

The third piece of information that changed my viewpoint on health reform for 2009 was a recent trip to Washington, DC, where for 10 days I discussed the outlook for health reform with a wide variety of people.  Coalition building and grassroots activism were topics that arose in many of my discussions and at the events I attended.  While such coalitions are not new to the health reform debate, the range of groups they are encompassing is broader than ever.  For example, over the last several years several coalitions have been created that have brought together groups that haven’t traditionally worked together:

What this all points to are broader and deeper collections of efforts and interests getting behind health reform in the months ahead.  What it doesn’t clarify is exactly what “Health Reform” will be.  The challenge for all of these coalitions – as well as for Congress and others – will be to see if the momentum of these groups, (and their agreement to common principles), can be maintained when difficult choices about the specifics of health reform legislation need to be made.  Or will their positions regress to the minimum that their membership can agree to, (a.k.a. regression to the least common denominator), which is what most groups do in order to prevent schisms that would lead to their dissolution.

Whether this happens or not will certainly depend upon the specifics of health reform proposals, how they are presented in the context of economic stimulus or recovery, (both for direct jobs creation/salvation and unburdening of American companies), how desperate the coalition members are to see change, and how well these coalitions and others execute the new principles and practices for the changed political and policy environment described in the National Journal article, and which are being embodied in post-election community organizing efforts.

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