THE TREATMENT JUNE 17, 2009
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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.
--Jonathan CohnÂ
7 comments
Except that when Dole was in a position of power he wasn't willing to support this kind of reform. It isn't that Dole is better than Gregg its that now that he doesn't have to run for election he is more reasonable. I am sure that bloggers at NRO are not enthusiastic about this compromise.
- CraigMcGil
June 17, 2009 at 2:31pm
I just read this at Huffington Post. I think it expresses the concerns many on the liberal end of the political spectrum feel about Obama. The president has already more or less embraced the Bush administrations policies on the economy and foreign policy. Will health care be the next domino to fall?
From Huffington Post:
Bill Maher appeared on "Countdown" on Monday night to discuss his disappointment with President Obama, asserting that if Obama doesn't act boldly on health care reform and other progressive issues, the Democrats could lose the midterm elections in 2010.
He was critical of Obama's speech to the American Medical Association today, since they're a lobbying group that he claims has obstructed previous efforts at health care reform.
"When I heard the president get that round of applause at the AMA today, that's when I knew we were in trouble."
Maher said that his editorial criticizing Obama on "Real Time With Bill Maher" on Friday night was greeted with cheers, which surprised him since his "very liberal Southern California audience" usually boos when he goes after the president.
"They're getting to the point where they're saying 'Yeah, we still like Obama. He's our guy. We're glad he's our president. But where's the beef?" And it's easy to make speeches. What's hard to do is stand up to corporations. Corporations and their incredible strength are what have ruined this country so far. And this president we thought might be the one to stand up to them. I'm losing hope. I still have audacity but my hope is fading."
Maher repeated his concerns that Obama was "caving in to corporations and lobbyists. The track record so far is not good," slamming the president for "not putting it on the line and standing up to the energy companies, the health care industry, the banks."
The lack of initiative could cause political harm, warned Maher. "If he doesn't act boldly, then he's probably going to lose the midterm elections. If he can't shove some progressive legislation down their throats now, I don't know when it's going to happen."
As he did on Friday night, Maher said that Obama could use a little of Bush's decisiveness - without the misguided policies.
"When he wanted to get something done, he got it done... If Bush could go to war in Iraq when nobody was thinking about it, how come this president can't get through something like health care reform in a way that the people really want when people are actually for it."
- iambiguous
June 18, 2009 at 12:59am
Couldn't agree with you more, George, on the fact that Obama needs a lot more of the Bush bullheadedness without the bullshit. There were actuallly times when I secretly admired W's "My way or the highway" approach to running the country. I violently disagreed with the madness but kinda admired the method. W and Deferrment Dick had cojones, no doubt about it.
For Obama...if not now, when? The public is behind you (so far) but that's starting to fade. Time to cash in the political chips before the deck gets too thin.
- desertdog
June 18, 2009 at 10:32am
I hear Maher and am tempted to agree. One problem, though. Selling the public on war after 9/11 and tax cuts is a hell of a lot easier than major domestic policy reforms like universal access to health coverage. As for George's suggestion that Obama is going down the Bush path on health care reform, remember that that path consists of nothing. It's important to be agnostic on means but firm on results. From what I've read, the financial regulation proposal doesn't sound too good on that score, and I wholeheartedly agree that Obama should not sacrifice the goal in pursuit of a bipartisanship that won't materialize. However, his ace in the hole is that people trust him because he seems like a reasonable fellow, and it's possible for us liberals to underestimate the extent to which Americans are "small-c conservative," as Obama once put it, and skeptical of massive domestic spending and systemic government-initiated reforms. We're very much a devil-we-know sort of people when it gets down to it, and Obama is sensitive to that. Overcoming inertia when so many influential oxes are gored and it's a major change is a difficult task for anybody at any time no matter which party is in power. If not now, when, is a good question. But, even now, caution rather than pigheadedness strikes me as the approach that, even if it doesn't win over a good many Republicans will win over the public, skeptical Democrats, and produce the best possible result. (When a big-tent party has big numbers in part due to making the tent bigger, it doesn't magically make conflict go away. Rather, it shifts it to within the tent to some extent.)
- jhildner
June 18, 2009 at 2:31pm
I'm not generally inclined to look to Bill Maher for policy advice--his talents lie in directions other than nerdishkeit. But I would like to see more spine in Obama on his core commitments. The Baker/Dole buy-in to this general approach does suggest what a meaningful bipartisan negotiation might look like (recall Ev Dirksen's role in enacting civil rights legislation in a time and galaxy far far away). But if the Republicans currently in office, particularly in the Senate, show no serious interest in being part of a constructive process, they forfeit any legitimate voice in the outcome, and it is time for the President and party leadership to use all tools in their repertoire--including the bully pulpit and the reconciliation process--to finally bring home this too long missing piece of the New Deal/Fair Deal/New Frontier/Great Society agenda. With, at the very least (in the absence of single payer) a robust and comprehensive public plan that can effectuate sound, research-based management of costs of drugs and unnecessary/ineffective procedures, while making affordable care available to all.
- weisbardaj
June 18, 2009 at 2:41pm
In the world of liberal commentary, fans of bipartisanship were hard to find last week. With Republican
- Anonymous
June 22, 2009 at 12:22am
Should the government require that employers either provide their workers with health insurance or pay
- Anonymous
June 30, 2009 at 4:26pm