Reform advances in fits and starts
“HEALTH-CARE reform should be guided by a simple principle: fix what’s broken and build on what works.” With those soothing words, Barack Obama tried this week to win over a faction that has more power than any other to scupper his ambitious health reforms: doctors. This took some courage, for the American Medical Association (AMA), the profession’s leading lobbying group, has traditionally been suspicious of grand schemes for reform. Addressing the group’s convention in Chicago on June 15th, Mr Obama promised to consider reforms to the country’s tort system that lead to “defensive medicine”. Noting that no other Democratic president had touched this topic, the AMA’s leaders heaped praise on Mr Obama after his talk.
That was a step forward for his reform efforts, but this week also brought a setback from the Congressional Budget Office (CBO). Mr Obama and congressional leaders have vowed that any health plan they develop together this year must be budget-neutral, so the views of the CBO’s bean counters matter a lot. The current plans to watch are the ones developed by Edward Kennedy, who chairs the Senate’s Health Committee, and by Max Baucus, who heads its Finance Committee. The former plan is already public, while the latter was due to be released later this week.
Alas, the agency has thrown a monkey-wrench into the works. Its assessment of the Kennedy plan argues that this supposedly “universal” scheme would cost a trillion dollars over 10 years but cover only about one-third of the country’s uninsured. On the heels of that shock, reports surfaced suggesting that the CBO’s assessment of the Baucus plan put its price tag at $1.5 trillion. That reportedly delayed the release of the Baucus plan this week.
Conservatives have seized upon the CBO reports as evidence that all the Democratic talk of fiscal responsibility and budget neutrality is mere guff to disguise an enormous expansion of government. Some on the left retort that it does not matter much what Republicans think, as procedural devices make it possible for Mr Obama to push any final health plan through the Senate with only 50 votes rather than the usual 60. True; but fiscally conservative Democrats (known as blue dogs) are also likely to find a profligate health bill unacceptable, possibly depriving Mr Obama of the 50 he would need.
So bipartisanship still matters, but is it possible? Tom Daschle thinks so. The former senator, who was meant to head up Mr Obama’s health efforts before he got into trouble over his taxes, remains an influential voice. On June 17th, the Bipartisan Policy Centre (an outfit led by Mr Daschle and several other former Senate majority leaders of both parties) released its own health-reform blueprint.
The worthies endorse several of the big ideas now gaining ground among reformers. They advocate far tighter regulation of the health-insurance market, along with policies that push individuals to purchase insurance. They endorse greater transparency, for example through better use of health-information technologies. And offer a variety of sensible suggestions for paying for all of this—including the modification of the tax exclusion that currently favours employer-provided insurance.
Their most striking suggestion, however, involves the controversial notion of a health-insurance plan run by the federal government. Liberals demand one, but the insurance industry and conservatives are dead set against the notion. Mr Daschle’s group has come up with an elegant compromise. Private insurers will be given five years to establish universal coverage. If they fail, the president would be obliged to submit a public plan proposal to Congress for speedy consideration.