The odds may be slight, but I believe there is still a chance for President Obama to pass a bipartisan health care reform bill, even if it represents a small incremental step that will improve access to health care and opportunities to reduce costs.
Of course there is some evidence that congressional Republicans are not interested in passing any bill at all. But I believe a new approach by the president might work. Start first with a group of thoughtful Republican conservative and moderate Senators -- those who have demonstrated the willingness and ability to work with Democrats on important issues. I would suggest, for starters, Senators John McCain, Ariz., Lindsey Graham, S.C., and Orrin Hatch and Robert Bennett, Utah, Bob Corker and Lamar Alexander, Tenn., and the two Maine Senators, Olympia Snowe and Susan Collins.
The president should invite these Republican Senators to the White House and ask them a single, simple question: What bill would you support to reform health care this year?
Based on what they have previously stated and stood for, I believe these and other Republican Senators would support health care reform legislation based on four principles: (1) increased competition; (2) increased transparency; (3) serious efforts to reduce health care costs; and (4) increased access of lower- and middle-income people to quality health care -- funded by actual, realized budget reductions and cash savings to ensure no increase in the deficit.
Here are some ideas that would apply to each these four principles:
(1) Increased competition
--preempt state laws and allow all to purchase insurance across state lines, not just insurance companies regulated within the state of residence;
--create national public insurance exchanges accessible to all on the Internet, requiring all companies to compete against each other on the exchange for a national customer base;
(2) Increased transparency
-- require all companies on the national exchange to itemize all policy coverage options on standardized forms, permitting apples-to-apples comparisons (and also giving insurance carriers the advantage of a level playing field within which to compete);
--similarly, require all physicians, hospitals and providers to disclose all fees and costs on the standardized disclosure forms, including providing patients the most current national and local data available to allow them to compare comparable costs of procedures, tests, services, etc.
(3) Reduction of costs:
--offer tax incentives to physicians who provide flat fees for all services, such as monthly fees for particular patients, rather than fees for particular services, which too often leads to over-testing and over-billing;
--establish a Bipartisan Medicare Commission, similar to the Defense Base Closure and Realignment Commission (BRAC): i.e., a bipartisan body, including key stakeholders such as representatives from the AARP, business, labor, insurance carriers, physicians, and hospitals, which would make recommendations every several years to reduce Medicare spending and waste, and, like the BRAC, all its recommendations for reductions could only be voted down by congress in their entirety within a fixed time period or the cuts would become automatically effective.
--begin the process of tort reform by at least giving physicians or patients involved in a malpractice case the option to choose expedited arbitration by panels composed of medical experts; and establish a bipartisan blue-ribbon commission of to propose reasonable limits on damages except in the case of proven recklessness and gross negligence.
(4) Increased access to healthcare -- with costs fully funded from actual savings and cuts
--extend Medicaid to more lower income people and fund subsidies to middle-income people to allow them to purchase private insurance on the national exchange – but only if these extensions of access can be paid for by realized, cash savings from budget cuts and from Medicare and other programs ;
--give individuals the same tax deductions for insurance premiums as employees who are currently covered by employer-provided insurance – but again, only if paid for by budget cuts and realized cash savings.
--Does this approach satisfy a liberal such as myself who supported comprehensive Democratic proposals guaranteeing virtually universal coverage? Absolutely not. But to me, it does achieve some reforms in the system that increase opportunities for increasing access and reducing costs. It may not be all the reforms we need. But to me it is certainly better than none at all.
And most important, it shows the country the it is possible for Democrats and Republicans to work together to make progress on health care reform -- something all the polls show the large majorities favor -- consistent with the president 's campaign theme that there is not a Blue America or a Red America but only a United States of America.
It may not be possible; it probably isn’t. But isn’t it worth a try?
Lanny J. Davis, a Washington attorney, served as President Clinton’s Special Counsel from 1996-98 and as a member of President Bush’s 5-Member Privacy and Civil Liberties Oversight Board. Mr. Davis wishes to thank Mr. John Mackey, CEO of one of his clients, Whole Foods Market, some of whose ideas for healthcare reform are reflected in this column.
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