The New Health Dialogue

The Congressional Recess appears to be a time for reflection. Both CQ Weekly and the National Journal have pieces this week examining the state of the health care debate, where it is going and what it will have to overcome.

In addition to the fact that both publications require subscriptions for their content (Sorry!), both articles cover common ground while surveying the health reform landscape. CQ takes a narrative approach, looking first at a rough working consensus among lawmakers over what reform should look like (e.g. shared responsibility in financing, insurance market reforms to provide coverage to all Americans) and the public support for change, before diving into the early areas of division. National Journal takes a more straightforward approach laying out four potential deal breakers for health reform.

Both articles note that the questions of how we finance reform and who pays what remains unanswered. Each note the realities of the budget and legislative schedules are testing the strength of bipartisan bonds, using the question of whether Americans should be able to choose between public and private health plans as an early example of partisan divides. As Len Nichols, the director of New America's Health Policy Program, told the National Journal, the issue of a public plan has become a tool for extremes on both sides of the debate who would rather disagree than reach a compromise.

Earlier this week, the Lewin Group, a consulting firm with actuarial expertise in health care, released a study modeling potential outcomes for "several variations on the public model." The Lewin study looks primarily at the impact of a public plan using Medicare payment rates. One potential scenario, not modeled by Lewin, is the kind of public plan compromise described by Secretary of HHS designate, Governor Kathleen Sebelius, during her hearing before the Senate Finance Committee. New America's Len Nichols along with actuarial consultant John Bertko laid out a similar proposal that would seek to level the playing field to ensure fair competition between public and private plans. The Center for American Progress has also released a proposal for public plan choice by which "through fair competition on a level playing field, the insurance marketplace is made more functional."

In an editorial on Tuesday, the New York Times concludes: "A new public plan is neither the cornerstone of health care reform nor the death knell of private insurance. It should be tried as one element of comprehensive reform." The emphasis is our own, because we hope when Congress returns from recess on April 20, they will continue to seek middle ground for substantive discussion on issues like the public plan and that they will avoid ideological battles in favor of mutually acceptable compromises.