Picking a New President – What’s the Diff?

In the midst of the media fanfare over the presidential primaries – with a nation tossed between calls for “change” and “experience” and rapt by battles over delegates and the ephemeral magic of momentum - it may seem odd to pause, sit back and wonder “Okay, so we’re getting a new president… what’s the big deal?”

For most of us, of course, electing a president is really about identity politics. No, not the “race card” kind – but the kind where we want to have someone at the national helm who represents our values. And that doesn’t count for nothing.

Politicians, however, would also have us believe that whoever’s the nation’s CEO also has a substantive impact on our lives and on the future of our country. For those who fancy themselves practical people that care about results, that’s a claim worth investigating.

In a series of articles, citizenJoe will read its political tea leaves to see what diff it’ll make who’s our next president and how they’re likely to change our – and the rest of the world’s – lives.

We kick off with an issue that’s safest to predict where a generic GOP and Dem candidate will stand: health care.

But before we do, it’s worth taking a brief detour to remind ourselves:

What is it, exactly, a president does?

As you know from civics class, the president isn’t in the law-passing business; his main job is to turn laws into reality. But a chief executive can have an imprint on legislation both through his veto-wielding power and, if he has a lot of political capital in the bag, by either shepherding his party or negotiating with the opposition to make some legislative waves (witness Welfare Reform and No Child Left Behind).

Any environmentalist will also glumly tell you that the prez has the power to nudge policy through regulation and enforcement (or non-regulation and non-enforcement), while a pro-life advocate won’t let you forget that perhaps the president’s biggest role is in appointing justices to our highest court.

All in all on the domestic front, though, a president only has so much say on what happens in our day to day lives. When it comes to foreign policy, well, that’s a world apart: the commander in chief reigns supreme (in spite of that little constitutional clause about Congress declaring war).

So how does all that power translate? Our first stop: health care.

(BIG disclaimer alert: In guessing the impact a president will have in the next two years, we’re assuming the Dems will keep at least a slim majority in Congress. That’s, of course, a big assumption to make, but safe enough to bank on.)

Health Care ’09- ’10

Prognosis-in-Brief

GOP in the Oval Office: barely break out the first aid kit
Dem in the Oval Office: a patchwork of mild reforms highly likely, with a small possibility of moderate-to-major reform

Democratic and GOP candidates aim to solve the twin problems of high healthcare costs (16% of GDP and rising) and high numbers of un-insured (__% of Americans) coming from almost opposite tacks. Dems want more Uncle Sam (in terms of paying for and regulating health insurance); Republicans want less.

But while would-be executives have ambitious – diverging – plans for shaking up healthcare, a Republican president is sure to be stonewalled by an unsympathetic Congress and a Democrat might find that America, for all its healthcare groaning, is still not ready for large-scale reform.

The full chart

GOP in Da House: With a Republican in office, the next two years will look a lot like the last two years; with the prez playing defense, vetoing offensive plays from a Democratic congress hot to expand federal heath care programs.

The one ray of progress would be in shifting the nation’s health records from filing cabinets to electronic databases, a move designed to avoid double treatment and shed light on best medical practices – which both parties are keen on. If McCain gets the number one spot, Congress could also finally okay buying drugs back from Canada.

But GOP hopes to deregulate the health insurance industry (letting plans cross state borders and choose their own standards of care) and give families more direct purchasing power (with tax credits to buy independent and high-deductible plans as well as health savings accounts) won’t get very far. Republican’s fetish for capping medical malpractice awards won’t get much more indulgement.

Dem in Da House: Depending on how sweeping of a healthcare mandate a Democratic president rides into DC with, we could see mild-to-medium-hot health reform.

As a no brainer, Congress will be able to push through the SCHIP bill that President Bush has swatted down twice, adding 2-4 million low income kids onto state health plans. Dems will also be able to give a one-two to big pharma by telling Medicare to bargain for cheaper drugs and letting Grandpa buy his lipitor from overseas.

But those are small fry reforms. The big question is how far a Democratic president can bring his/her mega-plans to cover all Americans while keeping costs down.

While there are shades of difference between the Democratic candidate’s playbooks, they share key features: each would set up a “menu” or “exchange” of private and public health care plans that individuals, families and businesses could buy into; families would get tax credits and discounts to help them buy in; and (all or many) employers who don’t cover their workers would have to pony up to pay for the new system. The $60 - $110 billion yearly price tag would be covered by cutting off subsidies for families making more than $250G and by a host of untried cost-saving initiatives.

While the candidates are aiming to avoid the pitfalls of Hillarycare – by, for one, making “choice” key – and while US business is aching to toss off the albatross of healthcare, one should never estimate the power of Capitol Hill inertia and that real bogeyman, the “special interest.” Getting the American people and the Chamber of Commerce to swing for change is half the battle. Without Pharma, the medical profession and HMOs on board, DC will either need a minor revolution or another ten years before it sees solid reform.

For more on the candidate’s health plans, see Kaiser Family Foundation’s choice breakdown at: http://www.health08.org/sidebyside.cfm