The New Health Dialogue

During his campaign, President Obama called on our nation to work together to solve great challenges. But was the president's health reform speech in Congress this week partisan, as some critics charge? Or did he leave the door open for bipartisan compromise?

Certainly the president "called out" those who distort the truth. Who can blame him? But he was not partisan. I am more sensitive to partisanship than most. In 2006 I watched my boss, former Sen. Lincoln Chafee (R-RI), fall to his Democrat challenger. Sen. Chafee voted against the war in Iraq, against drilling in the Arctic National Wildlife Refuge, and against amendments to ban gay marriage. He did not vote for President George W. Bush in 2004. Yet, Democrats ran countless ads linking the Senator to President Bush and his policies, particularly the Iraq war. Smart campaigning or not, it was partisan politics.

In contrast, President Obama did not cast aspersions in his address. He did not portray positions inaccurately. None of that. President Obama in his speech drew only one line in the sand. It was a very big and very nonpartisan line: we are going to address our health care coverage problems and we are not going to add to the deficit to do it. He made clear he is looking to solve our nation's health care crisis with anyone -- Republican, Democrat, or Independent -- who wants to solve it with him. He was also unambiguous, however, that he will not stand silent while people perpetuate misinformation to score political points.

Bipartisanship does not require silence in the face of unfounded rhetoric. The president was right when he said Congress already agrees on about 80 percent of his plan. Exchanges, insurance market reforms, subsidies, deficit neutrality, and tackling waste, fraud, and abuse are all initiatives that enjoy broad bipartisan support. In addition, President Obama left the door open for bipartisanship on more contentious aspects of reform:

• Public health insurance plan. The president signaled willingness to support alternatives to the public health insurance plan as long as every American is guaranteed a choice of affordable, reliable insurance products. In particular, he mentioned the possibility of a co-op or a conditional public plan that only goes into effect when prices are too high or competition is lacking. It is worth noting that the co-op idea was hatched during the Group of Six negotiations that include Republican Senators Grassley, Enzi, and Snowe and it was Senator Snowe who began talking up a "trigger" or fallback for the public plan months ago. The president's description was open-minded enough to elicit this from Chip Kahn, President of the Federation of Hospitals and former unabashed foe of the Clinton-era reform efforts:

"He worded it [the public plan] really carefully, because he said ‘not for profit' and he didn't say it had to be controlled by the government...The way he described it, we could support that!"

 

 

 

 

• Taxing insurers who offer high-cost benefits. Taxing insurers who offer high-cost benefits would be a big step toward slowing the rate of health care cost growth and making insurance affordable for the long-term. While the president has been clear he does not want to mess with the current tax free nature of employer-provided coverage, this proposal would achieve similar policy objectives: encourage insurers to deliver more value for their customers' premium dollars, bend the cost curve over time, and raise revenue from within the health system (something sought by fiscal conservatives).
• Medical malpractice reform. This is the biggie. Many analysts believe medical malpractice reform should be part of comprehensive reform -- not because "defensive medicine" has been proven to add much to the cost of health care (data suggest it likely does not), but because current malpractice laws are a black cloud over most clinicians. This issue, however, is incredibly polarized in Washington (think trial lawyers versus doctors). Despite the obvious political risk, the president did the right thing by putting medical malpractice -- long a Republican priority -- back on the table.

There is plenty of partisanship from both sides of the aisle to go around in Washington. Health reform should and can be different. As the president told Congress and the American people, the, "concern for the plight of others -- is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character."