R. Castellblanch comments:

I think that it is helpful that Uwe Reinhardt has suggested that the so-called PBOR is fated to be a weak bill at best. Despite the hype, the bill is unlikely to have much of an effect on access to health care. By the time the insurance industry lobbyists are done weakening the bill and have given the green light for its enactment (Bush would not sign the bill without, at least, their tacit consent); the bill will be quite unlikely to help many people gain access to health care.

In fact, by the time the insurance industry and other special interests are done with the bill, this could even be a bad piece of legislation. If it becomes a "moving vehicle", then it might end up being loaded with so many concessions to special interests both inside and outside of the health care industry that the concessions may outweigh its beneficial provisions. (Look what happened to the Kassebaum-Kennedy bill in 1996 -- while it has created little access, it has led to large problems for protecting medical privacy). Already, the Senate version of PBOR bill has a form of a federal preemption clause in it. This clause could greatly curtail state-based efforts at health insurance reform - efforts which have proven useful in generating grassroots energy for health access at the state level.

Ted Marmor has indicated to us that PBOR backers have mobilized the health reform community in Washington. Maybe, they might contribute some momentum to the efforts to expand health care access. I hope so. I think Professor Marmor's right in arguing that the health care grassroots is not being greatly diverted by the PBOR fight. With or without a PBOR, they would not be doing much at the federal level anyway.

However, I think that more useful issues for generating momentum for health care access are those that resonate with people outside of the Beltway. For example, seniors' problems getting access to prescription drugs and the problems that private insurers have caused the Medicare program have filled town meetings with angry people. These may be better federal issues on which to focus. I suspect that PBOR is not in this category. I don't recall discussions of PBOR filling town halls.

Still, if the PBOR does pass this Congress in a relatively clean form, it may be a small but significant contribution toward building some political momentum for health care access.

Ramon Castellblanch, columnist for the Hartford Courant 

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