The following is a guest post contributed by Steve Pizer, an Associate Professor of Health Policy and Management at Boston University School of Public Health. Earlier in his career he spent seven years as a legislative aide, researcher, and lobbyist for consumer and environmental organizations.
In an interview with Politico last Wednesday, House Speaker Nancy Pelosi suggested a seemingly puzzling two-track strategy to pass health care reform. She explained that she intended for the House to continue pursuing comprehensive legislation, but that she would simultaneously push individual elements of that legislation through the House on their own. Pelosi insisted that having the House proceed on smaller bills does not imply that the larger bill is a lower priority. “It doesn’t mean that the comprehensive isn’t moving. It is essential. If everyone loved their health insurance in the country — and you know they don’t — we would still have to do this for financial reasons,” she said.
What is she thinking? How can it make sense to push elements of reform on their own if comprehensive reform is still the goal? It appears to be duplicative at best. At worst, it seems like the first steps toward policy incoherence because, as others have pointed out, the components of health reform don’t work by themselves.
But what looks like bad policy might be good politics, leading ultimately to good policy. It’s possible that this strategy isn’t about actually passing the bite-sized pieces. The benefit comes from bringing them up and debating them. As the Pew Research Center has shown, most of the individual elements of comprehensive health reform are popular, but the voters don’t understand the comprehensive package. By shifting debate from the unpopular and caricatured comprehensive bill to the popular components of it, the Speaker may be able to change the public’s perception of what “health reform” means. If “health reform” starts to poll better, it will be easier to pass the comprehensive bill.