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President Obama and proponents of health care reform should adhere to a unified philosophical vision and avoid allowing the debate to focus on costs, Professor James Morone, chair of the Department of Political Science, told a packed MacMillan 115 Thursday night.

In a lecture titled "The Dirty Rotten Secrets of Health Care Reform," Morone outlined what he called the "10 commandments of passing health care reform" — factors he believes will largely determine the final outcome of the debate. Obama's success in reforming the system, he said, will largely depend on how well he and congressional Democrats stick to these recommendations. Among them are suggestions that proponents try to move as quickly as possible — should no bill be produced by February, he said, efforts will probably be ineffective — and to focus on symbols likely to appeal to the public, without getting lost amid "wonky" policy details.

Morone has written several books on politics and health care, including his July 2009 book "The Heart of Power: Health and Politics in the Oval Office" with David Blumenthal, currently an adviser to the president.

Morone began the lecture by outlining the history of health care reform, describing the efforts of presidents going back to Theodore Roosevelt to implement national health reform. Since then, Morone said, every administration has tackled reform with varying degrees of success.

Morone called the House of Representatives' passage of the Affordable Health Care for America Act on Nov. 7 "historic," noting that it was the first time in American history that a chamber of Congress has passed health reform on such a massive scale.

"There are some times in American society when we appear to be at a great change moment," he said, adding that such a success on Obama's part might signify a political seismic shift as significant as that of Reagan's election.

"Forget your papers, your exams, all that stuff. This is the moment," he said.

Conversely, he said, a defeat could cripple the president for the remainder of his time in office, much as it did President Clinton, who saw his own efforts to pass health care reform end in defeat for both his plan — which died in the Senate — and his party, as Republicans recaptured both chambers of Congress in 1994.

"If he loses, he's kind of toast," Morone said.

Later, Morone identified several key health care matters that Congress is attempting to address, such as rising costs. Between 1950 and today, health care inflation has been between two and three times higher than general inflation. During the George W. Bush years alone, Morone said, 2.1 percent of the GDP was spent on health care.

"We can't sustain this forever," Morone said. "Sooner or later, we'll do something, and that's going to hurt."

He noted that despite Republicans' emphasis on ending health care corruption and Obama's focus on increasing efficiency, neither change alone — or both together — would be enough to bring down costs.

Another problem that Congress must address is the high number of uninsured and underinsured Americans, he said, noting that roughly 47 million are without health care, while an additional 21 million have insufficient coverage. Morone shared an anecdote of an economist friend whose family's insurance policy covered everything except her son's left leg, which the insurance company concluded has a preexisting condition.

Because so many lack the coverage they need, he said, life expectancy at birth in the United States is 41st in the world, well behind that of many other wealthy nations.

"If our Olympic team were 41st, Congress would go nuts," Morone said. "There would be hearings."

Morone broke down Democrats' reform efforts into several key components, including a revamping of the insurance system — which would include preventing companies from denying coverage based on preexisting conditions and imposing lifetime insurance caps — and a public option to compete with private insurers.

Most important from his point of view, Morone said, were proposals to give subsidies in the form of tax breaks to low-income families to help them purchase health insurance. This measure, he said, would do the most to increase coverage.


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