A Health Care Compromise

From all reports, it sounds like both parties are planning their best impersonation of Madonna (the singer, not the Blessed Virgin) at the health care summit at Blair House on Thursday. Her 1990 song "Vogue" was all about striking the right pose.

My sympathies are, of course, more with the President and the Democrats than with the Republicans. But, I worry that the President’s political radar has gotten him to a place where it is difficult to win at this point. There appears to be no prospect of achieving bipartisan consensus, even if by bipartisan we mean no more than picking off Senators Olympia Snowe or George Voinovich from the GOP. I am not sure why negotiations broke down with Snowe in the first place. She had been insisting that there be a trigger for any public option, giving the private markets time to try and lower costs on their own before introducing a government competitor. Now, there is no public option in the President’s plan so it is unclear why the Democrats have not reached out to the Senator from Maine anew.


Be that as it may, the prospects for compromise are looking slim. The other day, California’s Governor Arnold Schwarzenegger urged both sides to keep negotiating, to find that "sweet spot" and arguing that "there is always a sweet spot." This is not true: Sometimes there is no sweet spot. The Republicans do not want health care more subject to the federal government and while their cries of "government takeover" are not true, it is true that the proposed Democratic legislation has a lot of "The Secretary of HHS shall" in its many pages. Where are the policy compromises to be found?

The key to any bipartisan compromise is not to split the difference but to weigh it. The GOP argues that its market-based reforms will cover more people and lower costs. They argue that the states should take the lead in reforming health care. Let them. But, if in four years, health care costs have not been lowered by a given amount, and a given number of Americans have not been covered, then everyone can buy into the federal employees health benefit package or Medicare. And, if after four more years, the Medicare buy-in has not covered everyone or reduced costs, future lawmakers will have eight years of experimentation and results to decide how to move forward. The GOP will have to vote for an eventual public option, in short, but that public option only takes effect if their own proposals fail to achieve the goals they claim they can make. In short, don’t take a little from the GOP proposals and a little from the Dems and try to shove it together into the policy equivalent of goulash. Put both plans to the test.

The more I think about this, the more I like it. The President’s plan, after all, would not be fully implemented for years so he really is not giving up very much. And, the GOP can hardly oppose a measure that says, "Fine, we will try it your way!" and even let's them go first. If they have the strength of their convictions, if they really believe their proposals will work, they have nothing to fear. The Democrats will have a form of single-payer system, an incipient one at least, if the GOP’s market reforms fail. That should be a compromise all sides can live with.

Michael Sean Winters



Comments are automatically closed two weeks after an article's initial publication. See our comments policy for more.
Brian Thompson
9 years ago
I am very leery (though not categorically opposed) of any sort of "trigger" legislation, since it would make a massively unpopular thing happen potentially on someone else's watch. If a plan gets passed and fails, we write new legislation.
As it is, I could live with some of the president's proposal. However, it also has some serious problems, and that is not even counting funding of abortion and such. My big problem is that it is simply too much central control. No, it is not a total take-over (though that is the stated goal of many of the bill's proponents), but is is very heavy handed. 
I would favor a simple, elegant bill that seeks to curtail costs naturally (rather than just mandating "make it cheaper, we have spoken"), puts the onus and control on the states to implement it, and has limited federal oversight geared mainly toward making sure the states actually are accomplishing the goals set forth, and regulating when there is some sort of interstate transaction going on.
The GOP plan is not a whole lot better, on the whole, but it does do many of the things I am looking for. If they truly want it to be bipartisan, they might try adding in some of the best bits from the GOP plan.
e.g. tort reform [that is, reform not abolition, incompetent physicians should still be accountable] yes, it's not a huge savings but a savings nonetheless;
Allowing and encouraging more co-ops or other group bargaining situations for small businesses or individuals (give them the same negotiation weight as massive corporations and unions); 
and freeing the market to allow people to shop for the best coverage for them, even if across state lines.
Now, for the poor, we do need to make a few considerations. The best solution in the world would be to fight poverty in general, but since that is an ongoing battle, we should work within the society to bring about greater charity in the realm of healthcare. Teaching orders and Nursing orders especially need a great revival: Vocations are key to putting a dent in this problem. Similarly, lay associations, pro bono professionals, and even secular charities (if they treat people as people, not just broken machines) are just as crucially needed.
Legally, we should surely make provision for the poor, and perhaps extending Medicaid in some fashion or encouraging states to make some provision is a good idea. However, I am again leery (though not categorically opposed) to massive federal legislation of social justice, it is 9 times out of 10 not any of the state's business to mandate that people be charitable. 
That was quick and unpolished and I need to get to class, but it is more or less what I think.
Think Catholic
9 years ago
"then everyone can buy into the federal employees health benefit package or Medicare"
Both of which currently prohibit abortion coverage, and would allow abortion coverage and federal funding thereof under any plan from the President and the Democrats.  So would you be for that or against it?  In July you promised you would be against it.  Will you be true to your promise?  Or are you willing to urge the President to compromise on everything except on abortion funding?
Helena Loflin
9 years ago
I think one of the reasons for holding the healthcare summit is for President Obama to give the Republicans something they can't seem to get enough of on their own...rope. The White House has already published online all of the Republican amendments that were incorporated in the existing bills which the Republicans voted against anyway.  So, any Republican whinning about being locked out of the deliberations is already trumped by published reality. 
The GOP "plan" is not a plan at all, but a few pages of goals with no "plan" on how to achieve them and no analysis of what the "plan" would cost.  As President Obama pointed out to the GOP caucus about their 13-page "plan" a few weeks ago, you can't say that you are going to pay for insuring an additional 30-35 million Americans by just cutting taxes. 
Brian Thompson
9 years ago
I may have read it wrong, but I do not think the GOP plan (available at their congressional website, and is over 200 pages, not 13), with which I support only parts, has as a goal (either short or long term) the direct federal provision of and/or mandate to acquire health insurance to those without insurance at present. The GOP claims that they wish to achieve the goal of health insurance for more people by widening the selection available in the market, and therefore encourage competitive pricing. They claim that they want to put the ball in the court at the lowest level possible, allowing groups of individuals and small businesses to band together for the purpose of collective price bargaining. They claim that this will lead to making health insurance a more affordable possibility for those without it at present who wish to acquire it. Now, their plan may be and probably is deficient in many of the details, but any solution that does not throw away subsidiarity in favor of increased top-down control is a plan I will be more apt to support.
Tom Maher
9 years ago
The fourteen month adventure in healthcare reform has produced a Senate bill and a Hosue bill that are inherently not reconcilable. Both bills attempt to do too much, in too many directions, and on too massive scale without inspiring any confidence that these bill would actually work to reduce healthcare costs.
The key healthcare reform problem the nation has discovered at this late date is that the Democrats do not have consensus amoung themselves, let alone with Republicans, on what healthcare reform should or should not be. For example, the prohibition of federal funding of abortion is firmly banned by the House bill but allowed by the Senate bill. This known issue of contention needed to be decisively dealt with from the beginning but was allowed to remain contentious among Democrats. This issue by itself is a "show-stopper". The clumsiness of severe government mandates matched against obnoxious governemnt giveaways do not meet anyone's expectations.
Why should the Republicans be blamed for the congressional Democrats' heathcare mess brought about by the Democrats' failure to have the needed consensus among themselve and the rest of the nation?
James Lindsay
9 years ago
Not only were there Republican amendments to the plan, but the plan itself is not that different than the one signed by Mitt Romney, a former Republican Governor. People are hiding behind ideology for political reasons.

Solidarity in this area must be mandatory, rather than up to the donors and subsidiarity is not violated for the simple reason that the tax system which supports health insurance for employees in larger firms is Federal. Essentially, this reform expands already existing Federal largess, which is why the argument that a federal takeover of healthcare (which this is not) is wrong headed and a bit pathetic.

Indeed, federal provision of healthcare would be quite good. I was treated quite successfully for hyperaldosteronism (which also mostly fixed my high blood pressure) by doctors in the Public Health Service at NIH. If only all doctors were in that system, health care would improve (and with no avenue for malpractice lawsuits).

Proposing a "private charitable option" ignores the simple fact that it does not work. Taxes on the wealthy are currently at their lowest point since World War II, with dividends and capital gains taxed at a very low rate - so low that deducting charitable contributions is almost unneccessary. Given the current environment, if the voluntary charity advocates were correct (that lower or no taxes would allow charitable giving to take care of what is now provided by government), the coffers of private charity would be overflowing. I assure you, the opposite is true.
James Lindsay
9 years ago
The Democrats can't get consensus with 59 members of the Senate, however 51 is a different matter. As far as Stupak, the Senate can't pass that part under reconciliation rules - however the House can probably put it into their version, allowing the 55 members of the Senate (probably 56 now with Brown) to concur without going to conference.

Also, the Senate Bill was, in fact, based on amendments to the House Bill (they did not use eithr Grassley or Baucus as a base), so a statement that they are not far apart is not accurate. The Obama text is actually based on negotiations between the House and Senate Democrats. If enough Democrats can be whipped up to go along with it (with a Stupak modification which must be added by the House), it will pass.

Starting from scratch is not necessary nor will it be required. Indeed, it would be impossible anyway with this Congress and this President (who refuses to adequately raise payroll taxes to fund both Medicare Part D and the aging of the boomers - as well as the expansion of Medicare to the 55 and over set - as well as raising enough general revenue to pay for expanding Medicaid to the poor and to meet the nursing home needs of the baby boomers). The other suggested approach is to shift all healthcare funding (Medicaid, Medicare and subsidies for private insurance) to an employer-only paid Subtraction Value Added Tax (meaning it does not show up on customer receipts) to fund a single payer system (with an opt out for providing direct medical - rather than insurance - services to employees and retirees (through hiring doctors and hospital-based rather than actuarial HMOs).
Charles Erlinger
9 years ago
Almost all of the utterances that I have heard so far today by participants in the health care summit, and, for that matter, by bloggers on the subject, have not been about health care at all, but rather, about either politics or insurance. What are the specific health care objectives that are sought by health care legislation?  Only then can strategies for achieving them be discussed rationally.  So far it sounds like the only objectives being considered are political and insurance objectives.  If universal health care is the objective, what, specifically does that mean?  Does the meaning include improving health as well as providing state of the art care of the sick?  If so, what is the relevance of either the political strategies or the insurance strategies that have been discussed to the achievement of those objectives?


The latest from america

Protracted and opaque processes only reinforce the fear that the church is still more invested in protecting itself than in protecting those who suffer from abuse, the editors write.
The EditorsMarch 21, 2019
Untold hours of dialogue, by both the underground and the registered church have left the church in a better position to navigate the challenges to come.
John A. WorthleyMarch 21, 2019
In the fourth and final episode of our mini-series with survivors, we are sharing the story of Michael Mack. Michael is the author of the one-man play: “Conversations with My Molester: A Journey of Faith.”
Deliver UsMarch 21, 2019
Gerry’s out this week, so instead of following our usual podcast format, we’re breaking out of the weekly news cycle to bring you an interview about a slow change that’s beginning for some really important people in the Vatican: Women.
Colleen DulleMarch 21, 2019