Disagreeing to agree

Our view: The health summit may not lead to a compromise, but Democrats have already moved toward Republican ideas on reform

February 26, 2010

A pattern emerged during yesterday's health care summit between President Barack Obama and members of both parties in Congress. Republicans argued that Democrats have gone badly astray in their efforts to reform the system and should be focusing instead on other things -- tort reform, allowing people to buy insurance across state lines, providing incentives for better primary care, and so on. Then the Democrats responded by saying they agree and have included some form of those ideas their legislation. The Democrats went on to talk about other Republican ideas they've incorporated -- health insurance exchanges, for example. The Republicans seemed unmoved, and if you've been listening to the GOP and its talk of liberal government takeovers of health care, it would be easy to dismiss the Democrats' claims.

But the truth is, the Democrats' plan is hardly some liberal dream. A liberal vision for health care reform would be something like Medicare for all. But that's not even part of the discussion. Instead, the president and Democrats in Congress have used preservation of the current, employer-based insurance system as the baseline for their reforms, and many of the ideas they have adopted were actually proposed by Republicans at one point or another. Democrats, and the president in particular, have made compromises, but the GOP keeps moving the goal posts for what constitutes bipartisan reform.

The individual mandate -- a requirement that all individuals have health insurance -- was originally proposed by Republicans, including some who now vehemently oppose it, in response to President Bill Clinton's health care reform effort in the early 1990s. Health insurance exchanges have long been championed by Republicans. The conservative Heritage Foundation helped develop the insurance exchange-based universal coverage plan in Massachusetts. The "Cadillac tax" on high-value health insurance plans was supported in the 2008 presidential campaign by Sen. John McCain (and opposed by then-Senator Obama). A form of the high-deductible, catastrophic-care insurance policies Republicans favor is in the bill, too. Reducing the growth in Medicaid spending, which used to be something Republicans favored, is in President Obama's bill but is now anathema to the GOP. Republicans insisted that no public option be in the final bill, and it isn't.

The Kaiser Health News Web site published a chart this week (http://bit.ly/9i1foE) showing the major features of President Obama's bill, House Minority Leader John Boehner's current proposal and a GOP health reform bill from 1993. Tellingly, President Obama's plan has a lot more in common with the 1993 GOP plan than the 1993 Republican plan does with the new one.

If Republicans had wanted to join in the health care reform negotiations in good faith from the beginning, they could have easily declared victory with the president's current plan. But at the beginning of this process, they made clear that they had no interest in sharing a victory with President Obama, and nothing that has happened since then has swayed them from that strategic judgment. Spending six hours on camera with the president is almost certain not to have changed that, no matter how many Republican ideas the Democrats agree to.

Readers respond

Everyone wants lower premiums, excellent benefits, long quality time with their doctors, the latest in diagnostic tools and medications, all people covered, happy doctors whose malpractice burden is low, no penalty for pre-existing conditions, no termination of insurance for sudden or severe illness and no lifetime cap on insurance payments. The private insurers don't want almost anything the American people want. Are you surprised the members of Congress can't get this reform bill passed? They are all, every last one of them, and this includes Obama, in bed with the private insurers.


A single-payer system is the only option that will bring simplified, cost-effective, and meaningful reform. The Dems have given up the most meaningful reform by dropping the public option from the plan.


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