While elected Republicans are busy polishing their Luntz-inspired, poll-tested talking points about a government takeover of the health care system and complaining about a ‘lack of bipartisanship,’ a bipartisan group of former Senate Majority Leaders — Howard Baker (R-TN), Tom Daschle (D-SD), Bob Dole (R-KS) and George Mitchell (D-ME) — have released a comprehensive health care proposal that incorporates many of the President’s principles. Jonathan Cohn has the details:
There is a requirement that businesses pay towards the cost of insurance for their employees, along with a requirement that everybody get insurance. To make coverage affordable and available to individuals and small businesses that can’t get coverage now, the bipartisan group would set up an insurance exchange; there, insurers couldn’t deny people coverage or charge them more just because they have pre-existing conditions. People buying insurance through the exchange would also be eligible for subsidies, depending on their income levels.
To pay for the plan, the bipartisan group would draw on a combination of new revenues and savings from the health systems — again, not radically different from the ideas now under consideration in Congress. They’d try to squeeze $500 billion out of Medicare and Medicaid, another $500 billion from new revenues including a cap on the exclusion for employer tax benefits, plus $200 billion in some other efficiency changes. That would make the measure revenue neutral, since projections (from MIT economist Jonathan Gruber) show the new outlays would add up to $1.2 trillion over ten years.
This may be the first comprehensive, bipartisan proposal that seeks to truly bridge the gap between the ideologies. As such, it has a little something for everyone. Progressives may be disappointed with the proposal’s reliance on federal standards as a minimum for benefits (although that’s just a minimum and states may go beyond if they chose), limiting the tax exclusion for employer-provided coverage (although retirees and collective bargaining agreements are exempt) and a state-based trigger that would allow the federal government to provide financial and technical assistance to states that want to establish alternatives to private insurance.
But this is what compromise looks like. In turn, Republicans Dole and Baker embraced Medicaid expansion, an employer mandate, an individual mandate, an independent health care council that would “make recommendations to improve quality of care and avoid unnecessary costs in federal health programs,” comparative effectiveness research “relevant to patient decisions and effective health care policy reforms,” funding for quality measures, and reimbursement reforms to reward quality and care coordination. These are no small concessions and they would have been unimaginable just 16 years ago.
The truth is, this fully financed proposal includes 70–80 percent of the President’s principles. It builds on the employer-based system and really goes a long way towards ensuring that all Americans have access to affordable and adequate coverage. But the politics are also important. Baker, Daschle, Dole and Mitchell know the Senate and the mechanics of achieving bipartisan compromise. Their endorsement is not only refreshing (given the current state of debate) but it’s also politically encouraging.