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The man in the arena

Sometimes I feel like Forrest Gump because, since I started on the Hill in 1983, I have just seemingly been in the middle of almost everything big that’s happened in healthcare,” Chip Kahn mused over lunch in downtown Washington last week.

During those three-plus decades, the man who is now the president of the Federation of American Hospitals has influenced healthcare policy and politics in Washington more than all but a handful of others.

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“I hope, though, that unlike Forrest, I actually made a positive contribution along the line and wasn’t just an idle observer,” Kahn said. “I was frequently in a position to make a difference and I hope I took advantage of that.”

As a Republican congressional aide, the chief lobbyist for the health insurance industry, or in his current position representing for-profit hospitals, Kahn’s played key roles in major initiatives, such as the creation of the Medicare prescription-drug benefit and the ill-fated Clinton health reform proposal.

As head of the Health Insurance Association of America during President Clinton’s first term, Kahn is credited — or blamed — with helping bring down the White House’s ambitious effort to remake the U.S. healthcare system. That failure, in turn, is cited as one of the reasons Republicans swept to power in Congress in the 1994 elections.

The political debate over health reform, and healthcare issues in general, seems to have been stuck in 1993 since then.

“The fact that it became so pivotal and then failed left an indelible mark on everyone involved and, I think, set the scene for people’s mentalities about health policymaking, just like the Depression set the mentality for all those people that lived through it in terms of their finances for many decades later,” Kahn said. “Everything is seen through that lens.”

But Kahn says he doesn’t have any real regrets. Indeed, though he takes credit for the infamous “Harry and Louise” ad campaign that many believe turned the public against the Clinton plan, Kahn believes the push was doomed from the start.

“I think it’s unfortunate that in ’93-’94, if you look in retrospect, there was almost an inevitability to reform failing,” he said. “I think the administration reached too far in terms of overhauling the system in the details, in the detailed plan, and at the same time was too rigid in the process.”

According to Kahn, the point of the “Harry and Louise” campaign wasn’t to scuttle health reform but to force the Clinton administration and congressional Democrats to take the industry’s concerns more seriously. The insurers “felt like we hit a brick wall when we tried to work with the administration,” he said.

“The purpose of Harry and Louise was really just to get their attention and get a seat at the table,” Kahn said. “But at the end of the day, the campaign was so effective that not only did it get the administration’s attention, but it also got the attention of the American people and we sold the argument, which I think was a fair one, which was that the plan as proposed had inherent weaknesses and that many people might be worse off under the plan than they were now,” he said.

The failure of health reform and the historic shift in partisan power that followed also revealed “fissures” among congressional Democrats that also contributed to the inability of the White House and the congressional leadership to overcome healthcare industry opposition, Kahn said.

Though the healthcare debate has remained bitterly contested since then, Kahn dates that condition back to 1988, when Congress and the Reagan administration embarked on a disastrous attempt to add a prescription-drug benefit to Medicare.

{mospagebreak}Seniors protested against increased premiums, most famously by accosting then-House Ways and Means Committee Chairman Dan Rostenkowski (D-Ill.) at a community meeting and chasing him out. The bill was hastily repealed, but the politics of healthcare were inexorably altered.

“I think that shift began when those seniors jumped on Congressman Rostenkowski’s car, and all of a sudden, there was — and I’m not value-judging it — an emotionalism about healthcare policymaking that hadn’t been there in the ’80s,” Kahn said. “I think that the old consensus began to fall apart around that issue.”

During those early years on the Hill, Kahn said health policymaking was more about consensus-building and less about politics. On Capitol Hill, Kahn worked under Republican Reps. Bill Thomas (Calif.), Bill Archer (Texas) Bill Gradison (Ohio) and John Duncan Sr. (Tenn.) and Sens. Dan Quayle (Ind.) and David Durenberger (Minn.).

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Prior to that, Kahn worked on political campaigns with the man who masterminded the post-health-reform GOP takeover of Congress. Kahn began his political career working for future House Speaker Newt Gingrich (R-Ga.) on the presidential campaign of New York Gov. Nelson Rockefeller (R) and later on Gingrich’s first two, unsuccessful congressional campaigns.

As a result of those political battles in the late-1980s through the mid-1990s, the two parties are deeply divided on how to fix the problems in the healthcare system. With the prospect of a new health reform debate in 2009, Kahn isn’t sure he sees the way out.

“I don’t know if compromise is possible on the major issues,” Kahn said.

“Their visions about how they would get to affordable healthcare [are] distinct. I don’t know how well they talk to each other. It would be very difficult to compromise between these two worldviews,” he said. “You’d have to have a tremendous will to do it … and I haven’t seen a will to figure out a way to really compromise on that.”

Nevertheless, Kahn is preparing for a debate of some sort next year, though he wouldn’t predict what form it might take. “My crystal ball is really cloudy,” he said. “Presidents only get so many wishes, so the question is, will the new president wish for healthcare reform? I think that’s up in the air.”