So what about health care reform?

By Michael J.W. Stickings

As is so often the case, Paul Krugman makes a compelling point today:

The whole world is in recession. But the United States is the only wealthy country in which the economic catastrophe will also be a health care catastrophe — in which millions of people will lose their health insurance along with their jobs, and therefore lose access to essential care.

Which raises a question: Why has the Obama administration been silent, at least so far, about one of President Obama's key promises during last year's campaign — the promise of guaranteed health care for all Americans?

I have long made the case -- and I make it partly from first-hand experience living there for many years -- that the U.S. has the best health care in the world... if you can afford it. Which is to say, the actual care aside, the system, one that leaves so many without insurance, and therefore without access, is an embarrassment (to say the least).

If there was ever a time to move forward with large-scale reform, now -- a time of "economic catastrophe" -- is it. On this I agree with Krugman. (Consider that, as the WSJ reported the other day, "[a]t least 25 states have enacted or proposed cuts in health-insurance programs for the poor, potentially leaving millions of patients with reduced levels of care or no coverage at all." -- via TNR's The Treatment)

However, it is not entirely accurate to say that Obama has been silent on the issue. While his focus, and that of his administration, has obviously been primarily on the economy, and on the stimulus package, in the very early days of his presidency, it seems unlikely that there have been no behind-the-scenes discussions both internally and with lawmakers on Capitol Hill.

On that front, House Majority Leader Steny Hoyer has indicated that there might not be any action taken this year -- what's worse, he wants to combine health care reform with an overhaul of Social Security, which could doom reform entirely and/or play right into the hands of Republicans) -- a position backed up by Majority Whip James Clyburn, but Henry Waxman, the influential chairman of the Energy and Commerce Committee, stated yesterday, definitively, that he intends to take action this year: "This is our time... We need to get this job accomplished this year and get a bill to the president." And Speaker Nancy Pelosi seems to agree:

There are some incremental steps that we are taking — first we did SCHIP, then in our economic recovery package, we have money to help stem the tide of people losing health insurance — coverage for Medicaid and COBRA. There is also money for quality, health IT, comparative effectiveness and wellness, and money for prevention. And we will take a major step forward this year to increase the number of people who have healthcare coverage,

declared her office, as reported by The Hill.

Does anyone really believe that Obama isn't somewhere behind all this, given his enthusiastic support for the SCHIP bill, given that reform advocate Tom Daschle is his HHS secretary, and given that he himself is committed to reform.

So, yes, while there are certainly legitimate concerns that health care reform will go nowhere this year, there is reason to be optimistic that Obama's "silence" will end and that, once the economic stimulus package is finally passed, it will be at or near the top of the White House's agenda.