Possible compromises for healthcare reform
While I do think that the success or failure of healthcare reform rests squarely on the shoulders of the Democrats in Congress and with the president, I still wish that Republicans would come aboard with some reasonable compromises. At this point, though, the Democrats have several options on the table and while I think there is reasonable room for compromise they could always….
….pass a healthcare reform bill via reconciliation. Yes, the Byrd rule makes this tricky. Serious holes could be shot through the bill. But it can be done. Democrats should seriously consider this approach given the continued strength of their majorities in both the House and the Senate. Whatever is cut out during the process can be added back in later. Rather than worrying so much about public opinion should they pass the bill in the wrong way, Democrats should worry about public opinion if the bill fails altogether. That’s a lot more memorable then some abstract legislative process with as benign sounding a title as “reconciliation.” But…
…if reconciliation is too daunting, Democrats could take a Republican bill and remake it into a bipartisan bill – rather than the other way around. Market and tort reforms could be coupled with subsidies (or vouchers) and some broadly popular reforms like an end to pre-existing condition clauses and some sort of optional national exchange. All the reforms I mention below could be packaged together as one bigger bill. Or…
….the Democrats could do this incrementally, with smaller moves and compromises made one at a time – in three or four separate bills over the course of a year or two or three.
First: expand Medicaid to 200% of poverty while at the same time deregulating the insurance market so that insurers could sell insurance across state lines. Shift the regulatory burden from the states to the federal government to avoid the same problems we’ve seen in the credit card industry. Finally, have the federal government pick up the tab for the Medicaid expansion.
In the next bill, introduce an excise tax on “Cadillac plans” while at the same time tackling tort reform. Toss in some vouchers (subsidies) for low-income families to purchase private health insurance. The Cadillac tax will eventually hit enough people to start a shift away from employee-based health benefits. In the future, the vouchers can be adjusted as more and more people leave the current system to purchase personal, portable insurance.
Third, lower the age of Medicare recipients to 50 while at the same time introducing significant means-testing. Change the fee-for-service model to one which relies on results rather than services rendered. In other words, have a Medicare bill that adds more healthy, younger people to the pool, while reducing benefits and/or raising premiums for wealthier elderly while at the same time changing the biggest and most fundamental flaw with how service providers are paid.
Somewhere in here pass a VAT. Put a bunch of money into community health centers, and nursing programs. Deregulate the medical cartels allowing more barefoot doctors, nurse practitioners, and midwives to provide more of our health services. Let low-cost, easy access, for-profit medical centers set up in shopping malls and other easy access places. Make sure Medicaid is accepted at these new walk-in clinics. Let Wal*Mart run them from its stores, all across the country. Let people start tax-deductible HSA’s regardless of the their health insurance.
And so on and so forth. Plenty can be done – even incrementally – to enact change in the status quo. Things can get better for people without enacting sweeping change that scares voters and kills the process in its tracks.