"Presidents can't do nearly as much as they'd like us to think." --
G. Colvin
In fact, the SOLE major campaign issue that George W. Bush has
delivered on is confirmation of the thinking public's doubts about his
abilty to be an effective, intelligent, honest, respected, helpful
president.
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"Health Care and History's Hand"
By Geoffrey Colvin
Tuesday, May 20, 2008; D02
The next president will have a fighting chance to defeat the lobbyists
and reform a broken system.
With the economy clearly the No. 1 issue in the presidential race,
it's time to get serious about what any president can and cannot
actually do about it. Which campaign promises are worth considering
seriously, and which are just poll-driven pandering?
On most economic matters most of the time, presidents can't do nearly
as much as they'd like us to think. Despite all the overheated
election-year rhetoric to the contrary, presidents can't do much to
create or destroy jobs -- at least not in the short run. Global labor
markets are changing in historic ways having nothing to do with who's
in the White House. For that matter, presidents can rarely do anything
significant to start or end recessions. You can blame George W. Bush
for the subprime mortgage mess -- giving presidents credit or blame
for the economy is a grand political tradition -- but it actually
wasn't his fault.
The reality is that presidents make im****tant, large-scale changes to
the economy only in those rare circumstances where history hands them
the op****tunity. When the top marginal income tax rate was 70 percent,
Ronald Reagan had a historic op****tunity to reform the tax structure;
everything since has been tinkering. Likewise, Bill Clinton faced a
historic op****tunity to revolutionize the federal welfare system. His
changes are widely regarded as successful, and that issue has since
been off the table.
What major economic op****tunity will history hand to the next
president? The answer is health care. No one can guarantee that
significant change will happen, but the forces are aligned to make it
possible.
Yes, that's what the Clintons thought in 1993. And although no one
remembers it, a federal program to cover catastrophic health-care
expenses was also attempted under Reagan. What's different this time
is primarily demographics. The baby boomers are 15 years older than
they were last time around, and they (or we, as I should say) have
always made the whole country pay attention to whatever is on their
minds. With the generation's oldest members now 62, mortality is
finally becoming real. Regina Herzlinger, an insightful health-care
expert at Harvard Business School, says this is the best reason to
expect action at last -- that it will be driven by the boomers, whom
she has called the "most manipulative, self-seeking and effective
generation this country has ever seen."
Other reasons reinforce the demographic imperative. Employers are
steadily dialing back medical coverage for employees and eliminating
it for retirees. As U.S. companies increasingly face competition from
foreign companies that don't directly cover their workers, that trend
will only increase. Yet medical costs continue to rise at rates that
far exceed average increases in incomes, putting U.S. consumers in a
squeeze that is becoming more painful. In addition, as a nation we
seem to have reached what pollster Daniel Yankelovich called "settled
public judgment" on the issue of the 47 million uninsured; it is no
longer controversial for members of either party to say that it's
unacceptable.
The next president will also face the beginnings of the inevitable
Medicare crunch. The effects are potentially catastrophic for the
federal budget and for the U.S. economy, but addressing the problem
will be traumatic for Medicare recipients, for taxpayers and for
politicians. The solution may require painful measures, such as an
increase in the Medicare tax and cuts in benefits. But packaging those
steps with some kind of broader health-care reform might make eminent
sense on Capitol Hill.
Could the historic op****tunity for health-care reform be denied? Of
course. More than 20,000 business lobbyists ply their trade in
Wa****ngton representing companies and industries that would all be
affected deeply by significant change. It could certainly be that when
the dust settles, the result is phony reform, a law that creates
complications and costs money but improves life for no one. Or the
result could even be nothing at all.
But the best bet is that the new president will try to do something
historic on health care. The op****tunity is there. The most im****tant
economic question for the next president will be how effectively he or
she takes advantage of it.
(Geoffrey Colvin is a senior editor at large for Fortune magazine.)
http://www.wa****ngtonpost.com/wp-dyn/content/article/2008/05/19/AR2008051902475.html
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