Is Bipartisan Health Care Reform Possible?

Is bipartisan cooperation on health care reform possible? If so, what would it look like?

Thomas Mann Senior fellow in governance studies, The Brookings Institution

Under current political circumstances, the answer to the first question is no; if it was affirmative, the answer to the second question would be a legislative package that looked pretty much like the bills already passed by the House and Senate but with a stronger dose of malpractice reform and leavening from Wyden-Bennett -- the Healthy Americans Act; introduced by Democratic Sen. Ron Wyden and Republican Sen. Robert Bennett. Let me explain.

There was and is no market among Republicans for bipartisan cooperation on health reform with President Obama in the White House and Democrats in control of Congress. Before Obama was inaugurated, Republican congressional leaders made a strategic calculation that the best route to reclaim the majority in Congress was to unify in opposition to all of Obama’s major initiatives, using the Senate filibuster whenever possible to kill those initiatives, speaking in harmony to discredit the product when it is not. Their political success to date has been impressive.

A parliamentary-like minority party working under a set of congressional rules (most importantly the supermajority hurdle imposed by the Senate filibuster) is a potentially potent force, especially given the enormity of our problems following the economic collapse and financial crisis and the unpopularity of measures needed to cope with them. Republicans have no political incentive to reverse course now; and the seven Republican senators whose co-sponsorship of the Wyden-Bennett bill in the last and/or current Congress made them natural participants in serious bipartisan negotiations have no political space within their party to do so. Overtures by Obama have repeatedly fallen on deaf Republican ears. If health reform passes this year, it will be with Democratic votes alone on a separate reconciliation bill incorporating changes in the bill that has already cleared the Senate.

If bipartisan cooperation depended only upon the election results and policy views of President Obama and members of Congress, a package is not hard to identify. The base bill would be a Democratic version because they won the last two elections big time and their approach reflected a pretty broad consensus in the policy community and among many of the key stakeholders. Markups in both chambers produced bills that used moderate means to achieve ambitious objectives; they relied mostly on private insurance and resembled approaches championed by some Republicans in 1993-1994 as alternatives to the Clinton health reform plan.

A commitment by a half dozen or so Senate Republicans together with a comparable segment of Republicans in the House to support the final product could have produced a bill that was more ambitious in reforming malpractice litigation and in empowering more individuals to shop for their own health insurance. One example of an effort to blend the Obama-Baucus and Wyden-Bennett approaches can be found here.

But in this era of polarized parties, a routinization of the filibuster, and the permanent campaign, it was not to be. If health reform becomes law anytime soon, it will be a moderate reform but perforce an all-Democratic one.

Norman Ornstein Resident scholar at the American Enterprise Institute

It is a tough and uphill slog to get bipartisan cooperation on anything these days, but especially the highly charged area of health reform. That fact is both frustrating and unfortunate, because there is a whole lot of common ground substantively.

The fundamental structure of the Democrats' approach is not socialist or anything within the same galaxy as a government takeover of health care; it is a combination of Mitt Romney's Massachusetts plan (which, by the way, 70 percent of Massachusetts residents -- including Scott Brown -- like) and the John Chafee/David Durenberger/Charles Grassley managed competition plan put forward in 1994 as an alternative to the Clinton plan. Add to it more generous subsidies for low and moderate-income people, a sizable dash of malpractice reform, more incentives for health savings accounts (HSAs) to empower consumers, and a set of national minimum standards to allow people to buy insurance across state boundaries, and you have a plan that ought to attract 70 or more votes in the Senate.

But our highly charged partisan and ideological current political dynamic makes that possibility a slim one indeed. Let's face it -- if the Senate brought up tomorrow the one major plan that has sizable bipartisan support, Wyden/Bennett, it would likely suffer the same fate as the bipartisan Conrad/Gregg deficit commission, with most of the Republican co-sponsors voting against their own bill.

So is there any hope for a bipartisan bill? Actually, yes. It depends on the fate of the health summit called by President Obama this week. A full and respectful airing of views would give Democrats an opening to take their merged alternative drawn from the House and Senate-passed bills and add to it some of those Republican ideas like malpractice reform and HSAs. The Democrats then could bring the new more robust bill back to the Senate for a new vote, challenging Republicans to offer some support, or at minimum to allow an up-or-down vote.

If that does not work -- if all 41 Republicans continue to filibuster -- then Democrats would have a stronger rationalization for going it on their own via reconciliation. Far better though to avoid that route and hope against hope that some bipartisan support is still possible.

Jonathan Cohn Senior editor at The New Republic and author of the magazine's health reform blog The Treatment

Is bipartisan cooperation on health reform possible? Well, that really depends on what you mean by "possible."

If Democrats and Republicans were both determined to address our health care problems -- the fact that tens of millions either don't have insurance or have too little insurance, and the fact that our system is a disorganized mess that costs too much for what it delivers -- it's easy to imagine what a compromise would look like.

Democrats would concede that their dream of a single-payer system is more than the political system could tolerate, while Republicans would concede that simply leaving insurance to market forces would make today's problems even worse. Democrats would agree to stop subsidizing expensive health plans through the tax system and to encourage more consumer awareness by allowing for higher deductibles; Republicans would agree to define a standard set of benefits for everybody and to insulate the poor from too many expenses. Democrats would embrace malpractice reform, turning on their traditional allies in the trial lawyer community; Republicans would agree to stop over-subsidizing Medicare Advantage plans, forcing their friends in the insurance lobby to live with cuts. And both sides would push forward on the delivery reforms they both favor, whether it's paying hospitals less if they have high rates of infection or encouraging the use of information technology.

What's that? This all sounds very familiar? That's because it's a pretty accurate description of the plans that the House and Senate passed last year and that President Obama endorsed. It's also similar to the proposal drafted, and then endorsed, by four former Senate majority leaders -- two of them Republicans -- through the Bipartisan Policy Center. If it's good enough for Howard Baker and Bob Dole, surely it's good enough for at least a few of today's Republicans.

But it doesn't appear to be. Not only have the Republicans rejected this reform scheme. They have vilified it, calling it socialized medicine and accusing its proponents of trying to create death panels. The origins of the "death panel" charge, by the way, was a proposal to expand a program that President George W. Bush's administration introduced to Medicare a few years ago.

So I guess the answer is "no." Bipartisan cooperation on health care is not possible, at least not with this group of Republicans.

Robert Laszewski President of Health Policy and Strategy Associates and author of the blog Health Care Policy and Marketplace Review

A bipartisan agreement on health care is possible.

It is the only way health care reform can happen.

It is not probable in 2010 -- Republicans would rather wait until after they actually achieve the gains in Congress they expect -- not to mention their base would not forgive them for taking Obama off the political hook he and the Democrats are now dangling from on health care.

Democrats are fearful of the reaction that would come from their base this coming November if they now gave up on the big health care bills that same base is rabidly mad at them for not already passing.

We can't avoid a health care reform bill much longer. Health insurance rate increases continue to outstrip inflation by a wide margin, our budget and deficit challenges are untenable in the face of health care entitlement costs, and the uninsured will only grow in the face of these escalating costs.

We simply cannot achieve something so big and complex as health care reform without the party in power getting political cover from the minority party. In the end, the lack of that political cover -- bipartisanship -- is what undid the Democrats in 2009 just as it did in 1994.

I hope it will be possible to start with a clean sheet in 2011 when the Republicans know what political cards they are holding and the base of the Democratic Party finally has no choice but to give up on ramming their left-of-center plan through.

What could it look like?

My sense is that it would have to embrace the key concerns that Republicans and Democrats each hold.

For Republicans that means a market-oriented system that gave consumers more choice and responsibility -- a system of tax credits in place of the longstanding employer-provided tax benefits.

For Democrats, that would mean a system with a strong foundation of universal coverage and guaranteed access. There is no reason why tax credits could not encompass the existing system of employer-sponsored coverage.

But coming to an agreement will be very hard. Unions will fight any system that puts more emphasis on choice and responsibility, and conservatives will have trouble with any kind of guaranteed access -- an expansion of entitlements. That is why it will be so important for there to be a bipartisan agreement -- to give each other cover from their own base.