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Harry and Louise Do a 180

E.J. Dionne Jr., Washington Post Writers Group, writes:
Remember Harry and Louise, the imaginary couple who appeared in the television ads that helped beat President Bill Clinton's health plan 15 years ago? That middle-class duo, which is to say a great many people just like them, has switched sides in the debate. The insurance companies and the drug companies that paid for the ads know that Louise's employer has probably restricted her health coverage or dropped her altogether. And who knows if Harry still has a job?

Chris Jennings, who was a senior adviser on health issues in the Clinton administration, says that all participants in the health care system see a vicious cycle at work unless government intervenes. It involves "more and more uninsured, which means more and more premium increases, which means more uninsured, which means more premium increases."

From the point of view of the interest groups, he adds, "that means less market share for the insurance companies, more uncompensated care by the providers, and less ability for people to afford high-cost prescription drugs."

Are you still wondering why the big interests, so far at least, are playing ball with congressional health reformers and the Obama administration? Leaders of the health industry know that unless more government money flows into the system, they will suffer along with everyone else.

But the toughest behind-the-scenes battles will be about how much the insurance companies, the drug companies and the providers are willing to give up to get a government bailout of the health system. That was the significance of a little-noticed line in President Obama's letter last week to Baucus and Sen. Edward M. Kennedy, the other Democrat leading the health-care battle in the Senate.

Obama wrote that "reform cannot mean focusing on expanded coverage alone." The president stressed that it also had to be about "a serious, sustained effort to reduce the growth rate of health care costs."

That sounds like boilerplate. It isn't. The hardest part of the health care fight, says Ralph Neas, CEO of the National Coalition on Health Care, may not be providing assistance for the uninsured - remember, that means expanding the customer base - but getting all the players to agree to serious cost controls. Neas' coalition includes both business and labor, both of which have been hit hard by spiraling health costs.

So by all means, let's welcome the drug and insurance companies to the health care bargaining table. But let's also remember that they are sitting at that table as a matter of urgent necessity. Negotiators should bear in mind that health care reform is as vital for them as it is for the now underinsured Harry and Louise.

I have a vague recollection of a Saul Alinsky quote something like: Sometimes you can get people to do the right thing for the wrong reasons...

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