Even before Ted Kennedy lost his battle with brain cancer late last month, Republicans were suggesting that health care reform had suffered in his absence--not because Kennedy was so devoted to the cause, but because he would have cut a deal with the Republicans. “In every case, he fought as hard as he could . . . but, when he recognized that he couldn’t get everything he wanted, he could get a good bill by working with the other side,” Utah Republican Senator Orrin Hatch said on ABC’s “This Week.” “If he was here, I don’t think we’d be in the mess we’re in right now.”
It’s true that Kennedy was the consummate dealmaker. His determination to reach across the aisle reflected, in no small part, his regret over one time he didn’t--during the 1970s, when President Richard Nixon put forward a health care reform proposal that Kennedy and his liberal allies rejected as too timid. But the wistfulness for Kennedy’s deal-making and, more broadly, his bipartisanship, overlooks a key detail. The deal on health care that almost came together in 1973--like the deals Kennedy later made on No Child Left Behind, immigration reform, and the Medicare drug benefit--involved Republicans who were willing to be part of the reform enterprise. Such Republicans are almost impossible to find today.
During the past year, Republicans have frequently said they want to work with Democrats. But the real story of the last few months is how unserious those pledges turned out to be. Although you wouldn’t know it from their rhetoric or the media coverage, there are not one but two ostensibly bipartisan proposals out there right now. Either of them could be the template for successful reform if even a few Republicans started pushing them seriously. But, even the ostensibly reasonable Republican senators whom Democrats have tried to engage--Mike Enzi, Charles Grassley, and Hatch--just aren’t interested. And it appears they haven’t been for a while.
Nixon's old proposal--which would have covered nearly all Americans, mostly through private insurance--is a reminder that Republicans haven’t always opposed health care reform, sight unseen. And, as recently as a few months ago, at least a handful of Republicans were signaling that they bought into the basic goals of health care reform: expanding insurance coverage substantially, improving the quality of medical care, and curbing the growth in health care expenses. “We’re going to make it,” Grassley said on CBS’s “Face the Nation” in July. “We’ll get this done because we’re doing it in a bipartisan way.”
The challenge, or so it seemed, was finding a way to accomplish these goals that meshed with conservative sensibilities. In practical terms, that meant relying heavily on private insurance to bring coverage to the uninsured, much as Nixon had proposed, rather than relying heavily on expanded--or even newly created--public insurance programs. It also meant minimizing taxes on the rich and fostering a sense of individual responsibility.
Earlier this year, a group of former Senate majority leaders--Republicans Howard Baker and Bob Dole, along with Democrats Tom Daschle and George Mitchell--showed how that might be accomplished. After negotiating with each other for more than a year, as if they were still in office and representing their two parties, the group (minus Mitchell, who had since joined the administration) unveiled a fully fledged health care reform proposal in June. They released it through the Bipartisan Policy Center, a think tank they’d establish precisely to advance proposals like these. And, at least on paper, it looked like the kind of scheme members of both parties could support in good conscience.
The Center’s proposal had the same basic architecture as the plan Obama put forward in his presidential campaign and that congressional committees have been debating this year. Everybody would have to get insurance; in exchange, government would make sure everybody could get insurance, by subsidizing the cost for those who needed financial assistance--and by creating a marketplace in which people without access to employer policies could get coverage regardless of pre-existing conditions.
Still, it was hardly everything Obama or the Democrats would have wanted. Instead of a single public-insurance plan into which people could enroll, the Center’s proposal would have given states the option of creating independent insurance plans to compete with private insurers; it allowed the federal government to step in with its own plan only if, after five years, there was evidence the system needed more competition. This was an effort to satisfy conservatives, who believe a public plan might drive private insurers out of business and, ultimately, starve doctors and hospitals of necessary resources by underpaying them.
The Center’s plan included other compromises as well. It expanded Medicaid eligibility to the poverty line but not beyond, while the House bill, in line with liberal expectations, raised eligibility to include people making one-third more than the poverty line. This change helped achieve another major goal: holding down the overall price of reform. All told, the Center’s plan called for $1.2 trillion in new government spending--a significant sum, to be sure, but less than initial Democratic proposals, which, according to most outside experts, were likely to cost $1.5 trillion or more. And, again consistent with conservative thinking, the Center did not simply impose new taxes on the wealthy, as both Obama and, later, the House Democrats would. Instead, the Center’s proposal would have paid for reform by capping the exclusion on group health benefits, then extracting savings from Medicare and Medicaid. It was, in short, a proposal in which both sides gave ground. “I had a lot of trouble with mandates, just as Tom had trouble with the public plan,” Dole said. “But, if we can’t compromise, how are you ever going to get a bill passed?”
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COMMENTS (4)
There are three separate and unique instances of brain cancer here. The first took the life of Ted Kennedy. The second turned the Republican Party into a right wingnut mush. The third infected the Democratic leadership in the White House and the Congress precipitaing delusions of grandeur---a grand and glorious bipartisan march into the annals of a nobler history.
Now, all of this plays out of course embedded in the cancer that never goes away. The one that oh so symbiotically links Washington and New York at the juncture of Broadwalk and Park Place.
The hope this time though is that with a new Party living at the juncture of Pennsylvannia Avenue and East Capitol Street, we can finally get pas ... view full comment
There are three separate and unique instances of brain cancer here. The first took the life of Ted Kennedy. The second turned the Republican Party into a right wingnut mush. The third infected the Democratic leadership in the White House and the Congress precipitaing delusions of grandeur---a grand and glorious bipartisan march into the annals of a nobler history.
Now, all of this plays out of course embedded in the cancer that never goes away. The one that oh so symbiotically links Washington and New York at the juncture of Broadwalk and Park Place.
The hope this time though is that with a new Party living at the juncture of Pennsylvannia Avenue and East Capitol Street, we can finally get past this...then past Go...then finally and at long last collect the accolades from a nation of very grateful citizens.
Only The Center may not hold.
The Center?
Cohn:
The Baker-Dole-Daschle proposal still isn’t everything liberal Democrats want. But it’s far more ambitious than anything than the Enzis of the world would tolerate--and a measure that would accomplish much, if not all, of what liberal Democrats can realistically hope to achieve in the prevailing political environment.
George:
Cohn spends the bulk of his post above focusing on the clash between the ever mutating cancer in the Congress. It's largely seen as a clash between ideology and personalities. The cancer that is crony capitalism is the [mostly] invisible miasma such that none dare speak its name.
On September 9th, President Obama will address a joint session of Congress and will not dare speak that name either. The closest he might come is some vague reference to the dastardly Blue Meanies in the insurance industry or of the "special interests" that care not at all for what is in "the best interests of the American people".
I say it is up to Cohn, Chait, Scheiber etc. at The New Republic to dare speak that which none shall name---loud and clear.
We little guys are counting on them to join Keith and Rachel in turning the mainstream media inside out and upside down.
Say that it's so, Jon, say that it's so.
george walton
d/a
You must be really getting disparate to resurrect the so-called "bipartisan" commission report. The commission operated out of well know law firm and seemed to be a subsidiary of that firm. No offense to the two distinguished ex majority leaders, but Senator Baker was the majority approximately 30 years ago and Senator Dole left about a decade ago. I do not believe that you would find any current Republicans who are engaged in health care that think they represent conservative thinking today. On the other hand, Senator Daschle was obviously going to be the top health care advisor and HHS Secretary and had co written a book with Jean Lambrew on health care reform so he is a current expert ... view full comment
You must be really getting disparate to resurrect the so-called "bipartisan" commission report. The commission operated out of well know law firm and seemed to be a subsidiary of that firm. No offense to the two distinguished ex majority leaders, but Senator Baker was the majority approximately 30 years ago and Senator Dole left about a decade ago. I do not believe that you would find any current Republicans who are engaged in health care that think they represent conservative thinking today. On the other hand, Senator Daschle was obviously going to be the top health care advisor and HHS Secretary and had co written a book with Jean Lambrew on health care reform so he is a current expert representing the thinking of the white house. So no one really looked at the "bipartisan" commission as representing true bipartisanship. The report disappeared within one 24 hour news cycle. Frankly, I am not sure that anyone even bothered to read it. It is absolutely not the basis for any compromise in this environment.
Good news. In another chapter of the Brooks-Obama bromance [Platonic, apparently; like a man and his dog taking turns holding the leash], David Brooks taps Barack on the shoulder in The New York Times this morning to offer him sage advice about the healtcare debate.
[Okay, you're probably thinking, "Obama wrote the damn column himself!"; but no, George Will assures me that he and Brooks wrote the whole thing themselves]
Now, where was I...
Oh, yeah, Brooks and Obama need to come up with a way to channel a "fundamental new approach" to healthcare in America through, among others, Edmund Burke, Charles Pierce, John Dewey and William James. In other words, fundamental change made to look like th ... view full comment
Good news. In another chapter of the Brooks-Obama bromance [Platonic, apparently; like a man and his dog taking turns holding the leash], David Brooks taps Barack on the shoulder in The New York Times this morning to offer him sage advice about the healtcare debate.
[Okay, you're probably thinking, "Obama wrote the damn column himself!"; but no, George Will assures me that he and Brooks wrote the whole thing themselves]
Now, where was I...
Oh, yeah, Brooks and Obama need to come up with a way to channel a "fundamental new approach" to healthcare in America through, among others, Edmund Burke, Charles Pierce, John Dewey and William James. In other words, fundamental change made to look like the tortoise negociating with the MSNBC hares to fix the race.
The current system is most dysfunctional George Hussein Brooks say because the capitalists who own and operate the healthcare industries are quite prepared to bankrupt the nation if it means sustaining the status quo. Call them the Bad Capitalists. But it would only be worse if we let the Bad Beaurocrats run it instead. What to Do?
Read on....
David Brooks:
If I were magically given an hour to help Barack Obama prepare for his health care speech next week, the first thing I’d do is ask him to read David Goldhill’s essay, “How American Health Care Killed My Father,” in the current issue of The Atlantic. That essay would lift Obama out of the distracting sideshows about this public plan or that cooperative option. It would remind him why he got into this issue in the first place.
Goldhill’s main message is that the American health care system is dysfunctional at the core. He vividly describes how the system hides information, muddies choices, encourages more treatment instead of better care, neglects cheap innovation, inflates costs and unintentionally increases suffering.
The essay is about the real problem: the insane incentives. Goldhill is especially good on the way the voracious health care system soaks up money that could go to education, the environment, economic development and a thousand other priorities. Health care, he writes, “simply keeps gobbling up national resources, seemingly without regard to other societal needs.”
Then I’d ask Obama to go to the Brookings Institution Web site and read a report called “Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth.” This report was written by a bipartisan group of battle-tested experts, including Mark McClellan, David Cutler, Elizabeth McGlynn, Joseph Antos and John Bertko.
This report also focuses on the key issue: perverse incentives. It’s got a series of proposals on how to restructure insurance markets, reorganize provider payments, change the way effectiveness-research findings are implemented and cap the employee tax deduction.
These aren’t pie-in-the-sky ideas. The authors have combed through the bills that are already out there. They’ve taken good ideas that are now in embryonic or neutered form. They show how the ideas would work if fully implemented. We’re not going to revolutionize 18 percent of the American economy overnight, but these proposals would put us on the path toward real reform.
We’re not on that path right now. Several months ago, President Obama made a promise: People with health insurance would be able to keep exactly what they have.
We all understand why he made that promise. He wanted to reassure people who are happy with what they’ve got. He wanted to mollify the industries that have a vested interest in the status quo.
But Obama’s promise sent the reform effort off the rails. It meant that efforts to expand coverage marched ahead, but efforts to fundamentally reform the system got watered down.
Instead of true reform we got a series of bills that essentially cement the present system in place. The proposals do not fundamentally challenge the fee-for-service system. They don’t make Americans more accountable for their own health care spending. They don’t reduce costs. They just add more people into the mess we’ve got.
The president made this promise to ease passage. But it ended up hollowing out the substance of the reform. And the political benefits didn’t even materialize. Voters are still spooked by the costs, the centralization and the cuts they are sure will come.
If I had a magic hour with the president, I’d tell him this is his ninth-inning chance. He can stay on the current path. He might be able to pass some incremental bill that extends coverage. But he won’t have tackled the fundamental problems that first drove him to this issue. He won’t have cut health care inflation. He won’t have prevented a voracious system from bankrupting the nation, defunding the schools, pushing down wages and impoverishing the young.
On the other hand, he can shift back to the core issue: the perverse incentives that make this system such a mess. He can embrace proposals—like the Brookings proposals or, more comprehensively, the Wyden-Bennett bill — that address the structural problems instead of simply papering over them.
This remains a politically risky strategy. There are many industries that have an interest in making sure health care spending rises to 20 percent of G.D.P., and then 22 and then 24. But the president’s in political hot water already. He got there trying to dodge the hard issues. He might as well be there because he’s fighting for something real.
There are many people telling him to go incremental. They’re telling him to just enlarge the current system a bit and pay for it by pounding down a few Medicare fees. But did Barack Obama really get elected so he could pass the Status Quo Sanctification and Extension Act?
This is not the time to get incremental. It’s the time to get fundamental. Reform the incentives. Make consumers accountable for spending. Make price information transparent. Reward health care, not health services. Do what you set out to do. Bring change.
george walton
[d/a]
We'll know better after the Congress returns, but it may be too late to save truly comprehensive reform. The atmosphere is so confused and poisoned now that it's hard to imagine any sane moderate Democrat attaching his/her name to anything that we progressives are willing to accept. Obama's best plan now might well be to attack insurance reform only, and save the cost problem for later. In effect, declare limited victory, admit that we're not ready for broader reform, and get on with his broader agenda (there is one!).
Both the agenda and the Progressive project are increasingly in jeopardy. This generation of Liberals has never recovered from the fallout from Vietnam; significant portions of ... view full comment
We'll know better after the Congress returns, but it may be too late to save truly comprehensive reform. The atmosphere is so confused and poisoned now that it's hard to imagine any sane moderate Democrat attaching his/her name to anything that we progressives are willing to accept. Obama's best plan now might well be to attack insurance reform only, and save the cost problem for later. In effect, declare limited victory, admit that we're not ready for broader reform, and get on with his broader agenda (there is one!).
Both the agenda and the Progressive project are increasingly in jeopardy. This generation of Liberals has never recovered from the fallout from Vietnam; significant portions of the electorate distrust us as dishonest and weak. And every time we get a chance to overcome this prejudice, we end up re-validating it instead. If the situation in Afghanistan continues to deteriorate, those people in need of the Daddy party (there are lots of 'em) will instinctively turn to whoever the Republicans can come up with, just like they did in '03, and if Obama's base feels alienated, the prospect gets pretty scary.
If instead, the Democrats can honestly confront the reality in front of us all, and cobble together an effective albeit limited solution to a real problem, they can regain as much of the initiative as it is possible to, given their woeful mis-handling to date. Then, they need to start shooting straight.