THE TREATMENT JUNE 17, 2009
Is it important to make health care legislation bipartisan? You can't answer that question without knowing what bipartisan health care would look like. And thanks to a quartet of former senators, we now have some idea. Sort of.
For the last year, Howard Baker, Tom Daschle, Bob Dole, and George Mitchell have been working to hammer out a common health reform vision through what's called the Bipartisan Policy Center. (Mitchell dropped out when he joined the administration.) Assisting them in this effort were two of the top health policy minds from each party, Mark McClellan and Chris Jennings. The group finally came to an agreement and, today, they're showing the world what it looks like.
In its broad design, the bipartisan proposal looks a lot like the plans going through Congress. There is a requirement that businesses pay towards the cost of insurance for their employees, along with a requirement that everybody get insurance. To make coverage affordable and available to indivdiuals and small buisnesses that can't get coverage now, the bipartisan group would set up an insurance exchange; there, insurers couldn't deny people coverage or charge them more just because they have pre-existing conditions. People buying insurance through the exchange would also be eligible for subsidies, depending on their income levels.
To pay for the plan, the bipartisan group would draw on a combination of new revenues and savings from the health systems--again, not radically different from the ideas now under consideration in Congress. They'd try to squeeze $500 billion out of Medicare and Medicaid, another $500 billion from new revenues including a cap on the exclusion for employer tax beneifts, plus $200 billion in some other effiency changes. That would make the measure revenue neutral, since projections (from MIT economist Jonathan Gruber) show the new outlays would add up to $1.2 trillion over ten years.
Note that the savings from Medicare and Medicaid reflect efforts to use payment reform as a way to drive down health care costs in the long run. The bipartisan group also calls for developing, and making use of, comparative effectiveness research to guide coverage decisions.
All of that should sound pretty good to liberals. What won't sound good--remember, this is a bipartisan bill, reflecting Republican input--is the floor for benefits, which is apparenlty less generous than what many liberals have in mind. (Sorry I can't be more specific; haven't had time to read at that level of detail.) And the public plan is pretty weak: States can charter plans on their own; if those don't work, after five years, the federal government can step in and create a stronger alternative. In other words, it's the state-based approach with a trigger.
It's not an ideal plan, from my perspective. Far from it. But it does demonstrate that when responsible conservatives want to be serious participants in the reform discussion, they can help produce reasonable legislation that would--at the end of the day--get pretty close to providing everybody with decent coverage while starting to restrain the rising cost of care. If Baker and Dole had votes in the U.S. Senate, I'd be feeling reasonably optimistic right now.
But, of course, Baker and Dole aren't serving in the Senate. Instead, we have the likes of Senator Judd Gregg, who just blasted a similar proposal as something that "Rube Goldberg, Ira Magaziner, and Karl Marx" might have conceived. If that's the way the Republicans are determined to act, then this bipartisan effort will only serve as a reminder of what might have been--with a different cast of characters, at a different time.