On Monday the President announced three basic principles for health reform:

“First, the rising cost of health care must be brought down; second, Americans must have the freedom to keep whatever doctor and health care plan they have, or to choose a new doctor or health care plan if they want it; and third, all Americans must have quality, affordable health care.”

After reading this, I was struck how this statement sounded similar to the principles for health reform in 1993 – So I dug out of my archives the “Health Security Cards” I’d gotten while working on that health reform effort:

(Paper card is on the left, and plastic card is on the right)

Comparing the two sets of principles it is clear that cost, choice and guaranteed access have continued to be top priorities.  Interestingly, in 1993, “Preserve Medicare,” and guaranteeing benefits “at work” were also specified, and the first bullet on the paper card guarantees “private insurance” – which may be different than the current push for a public plan option, which MoveOn.org declared in an email to be “the most important part of Obama’s plan.”

While I believe the current Administration is committed to Medicare, the solidity of support behind employment-based insurance has slipped in the last 15 years because outsourcing and offshoring have reduced the employment rolls of large employers, and a few major manufacturers have turned health benefits over to employer organizations.  (Note: some of these VEBAs have suffered greatly because of the auto industry’s troubles.)  In addition, some Congressional leaders have talked about changing the tax treatment of employer subsidized health insurance – although I think this is based on both policy and fiscal grounds because reducing the tax deductibility of such benefits could raise significant amounts to fund other parts of “health reform.”

This comparison also shows that it is important to understand the historical context for these issues, and that there are only so many words to describe the type of health system we want to guarantee: access, affordability, choice, compassionate care, quality……

What will happen with health reform this time around remains to be seen, but two things are clear.  First, the process this time is much more collaborative among Congress, the Administration, and private sector groups. And second, whether health reform involves new laws, regulations, or private sector voluntary actions, the details won’t be printed on the back of a card, and considerable effort will be required to guarantee that these changes improve access, affordability, choice, compassion, quality……