Road to Reform Lies Across the Aisle
President Barack Obama’s health care plans are floundering under the weight of their own complexity (the most recent House bill is more than 1,000 pages long), expense (approaching $1 trillion in new spending over the next 10 years) and ineffectiveness in “bending the cost curve.”
Believe it or not, he has my sympathy. The U.S. health care system does need reform — desperately. While I served as Sen. John McCain’s director of domestic policy during his 2008 presidential run, he and I grappled with many of the same health care conundrums. If health care reform were easy, it would have happened years ago.
So here is some unsolicited advice on how to rally bipartisan support for health care legislation now. Bipartisan reform is not just good politics; it is good policy. By embracing ideas that improve access to insurance, lower costs and improve quality without massive new government spending, Obama can allay concerns about a government takeover of health care and bring Republicans and moderates to the table.
Let’s begin with the substance:
Portability and choice: Most Americans have very little choice in health plans; even employers who provide insurance typically offer just one or two plans. The situation is even worse for Americans who lose employer coverage and then have to buy insurance on their own.
The president has embraced the idea of a national health exchange, where people could buy their own portable health insurance from competing private insurers (and perhaps a public option modeled on Medicare). Exchanges are a good idea, but the regulations that some Democrats want to add to the exchange will drive up health care spending — as has already happened in Massachusetts, which operates a similar, expensive and heavily regulated government-run exchange.
Malpractice reform: Obama and Congress need to get serious about tort reform. Although direct costs for medical malpractice lawsuits are estimated at only about $30 billion annually, the costs from defensive medicine are far higher. The McCain campaign and others have proposed that physicians who comply with best practices should be protected against frivolous lawsuits.
Health security: Something has to be done to ensure that the small numbers of Americans with serious pre-existing illnesses aren’t denied access to affordable private health insurance. However, plans under consideration in Congress would thrust expensive new regulations like “community rating” and “guaranteed issue” onto the entire individual insurance market to try to make insurance affordable for that small demographic. Instead, we should make sure private plans are as flexible and affordable as possible for the vast majority of Americans, and then concentrate on specific reforms for pre-existing conditions.
Costs: Worries about federal “death panels” shift the debate off the mark, but Medicare recipients are right to be concerned that Congress will pay for expanding coverage to the uninsured by limiting access to expensive tests or new drugs for diseases like cancer or Alzheimer’s.
Now let’s get to the politics:
As a lifelong policy geek, I believe the substance is important and essential. But I have also come to appreciate the importance of how you do business. For example, Obama should return to calling it health care reform, not hiding behind health insurance reform. The main issue is a better, cheaper health system, and insurance markets are only part of the problem.
The president should also stop saying that Republicans “have no ideas.” Democrats have already shamelessly adopted pieces of GOP campaign proposals on tax treatment of health insurance, Medicare efficiency reforms and covering high-risk individuals.
Moreover, to build the political momentum for a bipartisan, substantive bill, the president should make it clear that GOP concerns should be addressed and that no bill that strips GOP ideas as a matter of parliamentary legerdemain will earn his signature.
For example, the president should finally take the public option off the table. It’s the single-biggest sticking point for millions of Americans (not just Republicans) who are worried that the government-run plan would drive private insurers out of business, robbing them of the coverage they have, and like, today.
Obama came to office by promising a new era of bipartisanship. His plans for health care reform, however, have floundered as Congress has shut Republicans out of the debate and crafted partisan legislation that will increase government spending without alleviating any of our fundamental health care woes or reducing costs.
To build support for lasting, bipartisan reform, next week Obama should call on Congress to go back to the drawing board and reach out for good ideas from across the aisle. And he can lead by example, by borrowing some good ideas from Republicans.
This piece originally appeared in POLITICO
This piece originally appeared in POLITICO