I saw a piece of Obama's stump speech from somewhereville, Nevada last night. It was the part about his "big table" idea for starting the health care reform process. There's been a fair bit of traffic about this idea (much of it negative). I got to thinking about it and realised that there is an Australian precedent, of sorts.
As I understand it Obama's proposal is to get Doctors, Nurses, civil service experts, members of the legislative branch, consumer and patient advocates, the drug companies and the insurance companies (his throw away line: "they get a seat they don't get to buy all the seats") around a big table and put the whole thing on C-SPAN. The aim being to thrash out an new health regime for America that delivers universal cover. Can this work? There is an Australian example that might shed some light on this question.
In 1983 the Labor Party leader Bob Hawke was elected Prime Minister after about 30 years of conservative rule (interrupted by the 3 years of the Whitlam labor government) and inherited an economy that was deeply challenged by inflation (especially wage inflation) unemployment, strikes and high interest rates.
In his first month in office Hawke conducted an "Economic Summit" which involved both sides of politics, business, unions, academic experts and so on. It was held in the old parliament chamber and was broadcast live on the ABC (which is kind of like PBS except they get actual, you know, funding). There was much ridicule at the time but it really worked.
The substantive result was the "Wages Accord" which traded off moderated wage demands (and hence strikes) for pension schemes and productive based bargaining. This was a cornerstone of a set of economic reforms (along with deregulating the banks and floating the dollar) which set the country up for 25 years of economic growth. So much so that the Australian economy is now close to quadruple the size it was in 1983. Later in his first term Hawke set the approval rating record for an Australian Prime Minister.
Why did the Economic Summit work? Putting it on TV was key. It forced people on both the union and business sides to step away from the brutal behaviour they had been very used to using in smoke filled rooms. Putting everyone in the same room and appealing to a higher cause also cleared the air and forced people to be bigger about things. The thing also got momentum from what was a clear and dramatic mandate for change from the election held only a month earlier, aided by the fact that Hawke had been head of the union movement until a month before the election.
So, on the basis of that experience Obama's health big table has some of good points. Putting the thing on TV and forcing some fairly dark characters to face the glare of public exposure is definitely a good move. Putting everyone on the spot as a follow up to an electoral mandate for change is a good move as well. It would be foolish to expect the big table to deliver a finished policy that can be legislated straight away. (The final Wages Accord was negotiated in closed rooms with hard bargaining after the summit was over). But, it could provide a circuit breaker to set up a good result.
I like that Obama has approached the problem this way. It shows both imagination and an understanding of how leadership can deliver results. It's also a considerable risk and given the brutal forces and complex nature of the US health business it could well end in tears. But, it's well and truly worth a shot.