Will we see health care reform in 2009?

I was browsing the Kaiser Family Foundation's (KFF) health08(dot)org website to get the latest news on the impact of the presidential election on health care reform. KFF president and CEO Drew Altman has an interesting three-stage model to map out the political path to health reform. Most analyses focus on comparing and contrasting the major candidate's positions on the issues, and KFF does that too. But Altman goes a step further to analyze what's likely to come of it all.

• Stage 1 is the general election. With the economy in trouble and Iraq in the news, the candidates may not even focus on health care. Who knows, maybe the election will even reach the lows of previous battles and focus on such serious topics as flag burning, the pledge of allegiance and Willy Horton. If there's not a major health care debate in the election and exit polls show health care wasn't a major deciding factor, then don't expect much to happen.
• Stage 2 focuses on whether the new president decides to emphasize health care. Considering the high chance of failure and the need to engage Congress, even a president committed to health care reform may decide to emphasize other issues where there is more common ground. In that case, expect the president to press for relatively easy wins such as SCHIP reauthorization.
• Stage 3 considers the impact of the new Congress. If there's a willingness to compromise on a centrist deal then there's a chance something might happen. Otherwise it's unlikely anything much will emerge from Congress.

Elsewhere on the KFF site we learn that while health care is a relatively important issue in the minds of voters, young voters are more than twice as likely as older votes to list health care as a major concern. That's a significant contrast from previous years when worries about Medicare led older folks to place an emphasis on health care. This shift may also have significant implications in a McCain/Obama contest. Obama would appear to have the youth vote locked up, so rather than emphasize an issue that younger voters care about, Obama may be more likely to engage on other issues, especially Iraq.It's also interesting that McCain has recently come out in favor of means testing for Medicare Part D prescription drug coverage. It's an obvious first step toward means testing for the rest of Medicare, too. I wonder whether McCain is playing with fire on that one and whether Obama might even take him to task.Another possibility is that the candidates will link health care and Iraq. I can foresee Obama (or Clinton) admitting that their plans are expensive to implement but asserting that everything could be paid for with the savings from an Iraq pullout. McCain may continue emphasizing improved health care for veterans and propose that veterans receive vouchers for care outside of the VA. That could lead to a broader set of voucher-based programs to increase the portability of health care.