Earlier this month, Treasury Secretary Tim Geithner said something that should have raised the antennae of every health care reform advocate in the country, but has been drowned in the rising furor over AIG executives and other distractions.

From the Wall Street Journal:

The comment came at a committee hearing where Tim Geithner was testifying on the merits of the budget blueprint, which includes a long-term health fund drawn from projected savings in Medicare and Medicaid as well as cut in tax deductions for the wealthiest Americans.

Geithner called health reform a “moral imperative, an economic imperative and a fiscal imperative for our nation,” DJ Newswires said.

With the top money guy saying that, how can it be that some Congressional Democrats are trying to kill any effort to keep health care reform in the budget process? Yet, it appears as though that is exactly what they’re doing. I emphasize the word “appears”. Right now, the political waters are so muddy it’s difficult to tell the players from the spectators. Yet when reading between the lines, a certain strange clarity emerges. I recommend a steady diet of varied sources rather than the mainstream media’s versions, which usually center on one theme stubbornly determined to obfuscate the nuance of the political gambits in play.

This is big news: Democrats have mapped out their legislative strategy for passing health care reform this year. According to George Stephanopoulos, Democrats will work with Republicans to build consensus around a plan, and then, if that doesn’t work, they’ll write the revenue-generating-and-substracting provisions of whatever health care plan they come up with into the FY 2010 budget resolution. As important: the budget reconciliation process, which circumvents moderate Democratic and GOP discontent in the Senate, will NOT be used to set up a carbon emissions credit trading system. Cap-and-trade was always the tougher sell to Congress.

So, where are we in the process right now? It appears that conservative Democrats  are reaching across to try to start the consensus-building and rumbling about ditching cap-and-trade for this round. Since this is not a blog about green politics, I’ll leave the discussion of cap-and-trade policies for one about the health care prong of the budget.

In last night’s press conference, President Obama was asked about the budget process and how he felt about Democrats revising the budget to eliminate health care reform and the middle class tax cuts. His response was that he was confident whatever budget was ultimately submitted would have the provisions he required.

Nate Silver points out that in a down economy, health care problems worsen, largely because less Americans have health insurance, or the means to pay for health care out of their own pocket.

Health care problems, by contrast, tend to worsen in a down economy. The chart below indicates the percentage of Americans covered by private health insurance; recessions are indicated by yellow bars. There has been a secular decline in this number over time because of the graying of the population and other reasons (various government-run programs have made up some of the difference, but hardly all), but the problems have been particularly acute during and immediately after recessions.


(Note: this chart corrects in a change of accounting methods made in 1999).

For obvious reasons, moreover, a more robust alternative to employer-based health insurance is probably more appealing to Americans when more of them are concerned about losing their jobs. I don’t want to call health care an easy sell … but it’s a fight where the White House ought to be favored.

President Obama has made it clear that a budget without health care investments is not one he will approve.

At the end of the day, the best way to bring our deficit down in the long run is not with a budget that continues the very same policies that have led to a narrow prosperity and massive debt. It’s with a budget that leads to broad economic growth by moving from an era of borrow and spend to one where we save and invest.

And that’s why [sic] clean energy jobs and businesses will do all across America. That’s what a highly skilled workforce can do all across America. That’s what an efficient health care system that controls costs and entitlements like Medicare and Medicaid will do. That’s why this budget is inseparable from this recovery — because it is what lays the foundation for a secure and lasting prosperity

No matter what you hear from cable news and other mainstream sources, remember that politics is a sport of deception, negotiation, and ultimately, compromise. The best thing we can do right now is keep the pressure on our elected representatives to make health care reform happen, and happen in a way that will actually work.

NPR:

• How Obama Can Heed Clinton Health Reform Failure

  As President-elect Barack Obama prepares to take office and confront the problems with the nation’s health care system, some people in Washington are feeling a sense of deja vu.

  In 1993, Bill Clinton had just become president, and his party was in the majority in both the House and Senate. There were tens of millions of people without health insurance and high hopes for change.

  That health reform effort crashed. The policy experts involved in that initiative say the Obama team will have to do things differently if they want to make change this time.
  Podcast

• CNN’s Dr. Gupta May Be Next Surgeon General

Health Affairs Blog

• Health Spending Slows, But Still Outpaces Economy Slowdown

  Health care and the economy. Health spending growth overall outpaced the slowing economy and consumed a larger portion of gross domestic product in 2007, reaching 16.2 percent, up from 16 percent in 2006. Although prescription drug spending slowed significantly in 2007, reaching its lowest rate of growth in 45 years, most other health care services grew at about the same rate or faster from 2006 to 2007, the government said. Writing in today’s New York Times, Robert Pear noted: “In recessions, when the economy contracts, health spending usually continues to increase. So federal economists and statisticians said that health spending probably accounted for an even larger share of the nation’s economic output in 2008.”

• The Surgeon General: A Partner In Health Reform

  But over the past 50 years, even as these valiant efforts and life-saving programs saved countless lives and raised awareness, our health care system has fallen apart – and more recently, the Surgeon General’s voice has been muted. Now that President-elect Barack Obama has proposed Tom Daschle and Jeanne Lambrew to lead his new health reform team, it’s time for us to redefine the Surgeon General’s role as someone who can not only diagnose what’s wrong with our health care system but work with us, as a team, to fix it.