The New Health Dialogue

With Vice President Joe Biden presiding, the Senate passed the health bill this morning. We are finally nearing the end of our long and winding road to comprehensive reform. There is much to celebrate: we have committed to making decent health insurance and quality care accessible and affordable for (almost) all Americans. That commitment -- an ancient obligation of any just community -- is vitally important, and hard to repeal, which is why some opponents fight so hard against it.  Political commitments to fellow human beings’ well-being are hard to retract.

We should also celebrate the commitment to making our health system better and sustainable, i.e., to reducing cost growth while improving quality of care over time. Neither the Senate bill nor the House bill is perfect in this regard. But both take huge steps forward and have been unfairly maligned by people who do not read, do not understand, or choose to ignore key provisions, and by those whose self-interests are served by the status quo.

We’ll publish more about details as the conference and final proposals work their way to President Obama’s desk. My main lament today, outweighed but not extinguished by the joy of the season and the  reality of 60 votes, is the lack of Republican support for the real reform we need, much of which is actually in the legislation before us. Long after the call for bipartisanship became unfashionable, I continued to work and call for it.  I believe bipartisanship would have been preferable in the long run. It would allow us to move ahead with less combat and more cooperation as we work to implement and build on this historic reform in the coming months and years. Bipartisanship means, as Senate Majority Leader Harry Reid put it this morning, not looking at health reform through a "political lens" but as a means of alleviating human suffering.

Too many on the Republican side choose, however, to make this about fierce politics instead of wise policy. The politics of denying President Obama and the Democratic Congress a victory are obvious. I understand the impulses and can even forgive some rhetoric and stunts in pursuit of that goal. But not all of it. Not by so many.

But it is wrong to label health reform as passed by either the House or Senate a purely partisan Democrat bill, or, to quote Mitch McConnell, “an attempt. by a majority to take over one-sixth of the U.S. economy -- to vastly expand the reach and the role of government into the health care decisions of every single American."I would note that the Senate bill in some respects can trace its roots to ideas put forth by moderate Republicans, particularly by the late John Chafee (R-RI). Chafee  proposed  “exchanges” for small employers and an individual mandate back in 1993.  His bill was also partially paid for with savings from Medicare including provider payment reductions and increased Part B premium payments for high income beneficiaries. He had 15 co-sponsors, including current Republican senators Orrin Hatch, Bob Bennett, Christopher Bond, Richard Lugar and Chuck Grassley, as well as then-Republican Arlen Specter.  With the exception of Specter, these influential Republicans were FOR this sensible, achievable model of health reform before they were against it. They were for re-organizing dysfunctional insurance markets and for making Medicare more efficient to help finance the subsidies necessary to help lower income people afford insurance. What changed to push them into such blanket opposition to these very same policies today? This is a very serious question..

The House and Senate bills run some 2000 pages in large part  because they preserve and build on the current mostly employer-sponsored system rather than replace it whole cloth. The core of the bill -- despite whatever Glenn Beck may have told his audiences to the contrary -- is the use of market incentives. It is a better regulated market, a market that will be more equitable and more efficient. But it is market incentives and forces that will provide access to competing private insurance plans and to entice higher value care -- i.e., higher quality and/or lower cost care. (And we know that we can get higher quality for lower cost because innovative pioneers are already providing it.).  To argue that the bill is about tyranny or socialism or euthanasia or all the other crimes that have been alleged is willful misrepresentation. Everyone is entitled to their opinion, but not to their own set of facts. 

So, is bipartisan health policy in our country dead? Certainly for a while, but here’s two reasons I think, and hope, not forever. 

First, brave Rep. Cao (R-LA) and serious Sens. Snowe and Collins (R-ME) all know the people in their states (and other states) are badly served by today’s small group and individual insurance markets and the crushing and rising cost of care.  They may or may not vote for final passage when the House and Senate bills are merged. But I believe they will not succumb to the Jim DeMint wing of the Republican party’s demands to blow reform up at all costs. I believe they -- and I hope others -- will work with Democrats in coming months and years to see that reform succeeds. For the sake of their constituents and the country.

Second,  we must bend the cost curve. The only path to fiscal balance in the long run is to reduce Medicare cost growth.  An awful lot of serious leaders in both parties understand this fact, despite all the misleading political rhetoric poured out this year.  It would be far preferable to address Medicare and our economic problems on a bipartisan basis in the future. Better for our most vulnerable Medicare beneficiaries, providers, and taxpayers alike. Last August’s rhetoric about rationing and "killing grandma” proves how hard it is when one party refuses to be intellectually honest about the challenges before us. But the longer we pretend this is a one-party problem, the higher the ultimate cost to us as a nation.  Republicans who are serious about the deficit and long term debt issues should ask themselves this question: what is Mitch McConnell’s plan for bending the Medicare cost curve?  And when they get the correct and wholly unsatisfactory answer, we invite them  back to the bipartisan policy table, to build on the foundations already in the bill that just passed the Senate.

They know we have to succeed, and I strongly hope they are patriotic enough to want to help. Maybe someone smarter than me can find a way to let them share in the credit, as they would then deserve. Win-win, instead of no-no. In my disappointed but still hopeful opinion, they can still find willing partners on the Democratic side to build a common future, should they muster the courage to lay down the partisan posturing of this fateful year.