Peter Harbage

President, Harbage Consulting

By Isabelle Walker

There are musicians’ musicians. Artists favored by other artists. Names little known to the public who, nevertheless, play an influential role behind the scenes.

In the arcane, but critical, field of health policy, Peter Harbage is the equivalent creature, a thinker’s thinker, if you will. He is well known in the wonky circle of well-sourced journalists and prominent health policy makers intimately involved with reform – influential thinkers such as Harvard Professor David Cutler, the senior policy adviser to President Barack Obama during his campaign, or Douglas Holtz-Eakin, who guided Senator John McCain’s health policy thinking during his campaign. And his imprint is evident in some of the key issues under debate on both sides of the aisle in California and nationally.

Harbage has never been inside of Arnold Schwarzenegger’s famous smoking tent in the California Capitol, yet he played an instrumental role in shaping key ideas for the health reform proposal put forward by the governor in his unsuccessful attempt to introduce sweeping reforms in California in early 2008. Harbage also served as senior health policy adviser to Senator John Edwards during both of his runs for president.

In those efforts, as well as in his consulting role to Gov.Schwarzenegger, he urged a moderate path that would ensure more access without upending the existing private insurance market. Edwards was the first candidate to propose a health insurance mandate for children, which Obama incorporated into his health care reform plan. Harbage’s straight-talking style and insider knowledge make him one of the most popular speakers for the Health Journalism Fellowships as well as a valuable source for journalists who follow health policy closely.

Harbage cut his teeth in health policy early. As a prize-winning graduate of the University of Michigan, he won an internship at the White House that eventually landed him on First Lady Hillary Rodham Clinton’s Task Force on National Health Care Reform. Immersed in the intricacies of health policy, nose to nose with the nation’s most powerful, Harbage was hooked. “I fell in love with the issues and the policy,” he said. “The opportunity to work on something so important was really something else.” Though his efforts have yet to result in reform -- Clinton’s efforts ultimately failed, as did Schwarzenegger’s – he prefers to see these disappointments as bumps in the long road toward reform.

When the Clinton task force disbanded, Harbage returned to the University of Michigan to get a master’s degree in public policy, and he has been researching, analyzing and helping shape various health policies ever since. Today he is president of Sacramento-based Harbage Consulting, Inc. His clients are political candidates, elected officials, think tanks, government agencies, and foundations. He’s also senior fellow at the Center for American Progress Action Fund, a think tank founded by President Bill Clinton’s former chief of staff, John Podesta.

Though most of the policy proposals he helped craft have been shot down in state houses and in Congress, one brought health services to millions of people: the State Children’s Health Insurance Program, or SCHIP. In the second half of the Clinton Administration, Harbage was assigned to the team that turned SCHIP (called Healthy Families in California) into an operational health plan for low- and moderate-income children in all the states.

From 2001 to 2003, Harbage served as assistant secretary of health for the California Department of Health Services, where he managed the nation’s largest state-operated health insurance programs for low-income families. In 2007, while working for the progressive New America Foundation, Harbage advised Schwarzenegger’s health experts as they developed and tried to enact a sweeping health care plan for California, arguably the most ambitious proposal for expanding health coverage since “Hillary Care.” It was ultimately rolled into a bill authored by then-Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata and rejected by the State Senate, an outcome Harbage blames on a failure of leadership.

Many people would find the two steps forward, three steps backwards aspect of health care reform frustrating, but Harbage understands that stops and starts are inevitable. “The challenge is that we have spent, in the United States, a very long time developing a very broken system,” he said. “Our health care system started off based on the notion that health care was a reward for work . . . and we struggle with that everyday because now we’re talking about creating a system that’s universal, and it’s just fundamentally different.”

Twenty years from now, Harbage predicts there will be affordable, comprehensive coverage for all Americans. Educating journalists about the intracacies of the health care system, which has its own bewildering tangle of acronyms and relationships, is just one of his contributions along the way.