As Republican leaders and the White House haggle over the details of the February 25 health care summit, conservatives have an opportunity to highlight the ideas they think could improve the health care marketplace while lowering costs, increasing the number of insured, and protecting what Americans like best about their health care system. Many of those ideas are included in Jeffrey Anderson's "small bill" proposal for health care reform. Read it!
Republicans want to expand the use of health savings accounts, to cover routine expenses for people who enroll in high-deductible health plans. Democrats denounce such accounts as a tax shelter for higher-income people.
Many Republicans want to expand the role of private insurance companies in Medicare. Insurers already manage Medicare’s prescription drug benefit, and Republicans see that as a model.
Republicans agree on the need to slow the explosive growth of Medicare, but say the savings should be used to shore up Medicare, not to help finance a new entitlement program.
The Times reporters also note that many conservatives and Republicans, such as Paul Ryan and Tom Coburn, support ending the unfair tax treatment of individuals who purchase their own health insurance on the individual marketplace. The reporters also briefly mention medical malpractice reform. But they leave out the GOP call to make it easier for folks to buy insurance across state lines.
What struck me about the article was that the most effective criticisms of the Republican ideas came from the reporters themselves. Each GOP idea had a caveat appended to it giving the liberal point of view. Nothing wrong with that--it's fair and balanced! But then the reporters quote actual Democratic legislators, whose counter-arguments are limited to this:
The proposals are “as skimpy as a hospital gown,” said Representative Lloyd Doggett, Democrat of Texas.
Representative George Miller, Democrat of California, said, “If the Republicans’ health care plan was a plan for a fire department, they would rush into a burning building, and they would rush out and leave everybody behind.”
At least Doggett's line is funny; I don't even know what Miller is talking about. The bottom line is the elected officials quoted in the piece give no indication of wanting to incorporate conservative principles into the final health bill. Nor, for that matter, does the White House.
Why? Part of it is partisanship. But the other part is that liberals and conservatives simply have different goals for health reform. The liberal dream is for a national plan that insures every American and uses government power to control costs, dictate mandatory benefits, and determine the "comparative effectiveness" of various treatments. Liberals think the health care system is in crisis and needs to be significantly overhauled.
Conservatives do not. (Nor do the vast majority of Americans who have insurance and are pleased with it, even if they also think it costs too much.) Rather, conservatives want to open the health care sector to market dynamics that stand a good chance of lowering costs while making individual insurance easier to buy. Universality is not a top priority; if anything, many conservatives and libertarians care passionately about preserving the right of the individual not to be insured.
With such wildly divergent perspectives, bipartisan compromise is a dream. But that is no reason to miss an opportunity to engage in a civil debate.