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Is The Healthy Americans Act a Basis for Compromise?

Few people have spent as much time talking up the benefits of Sen. Ron Wyden's (D-Ore.) Healthy Americans Act as I have. It's a genuinely good bill with a good Congressional Budget Office score and an innovative approach. I would support it, or at least something close to it, over anything on the table today. But contrary to what David Brooks implies in his column yesterday, the 14 bipartisan co-sponsors are not a reason to assume the bill's viability. Contained among the 14 supporters are precious few votes. Take the statement Sen. Judd Gregg (R-N.H.) released when he signed on as a co-sponsor:

“With health care reform so urgently needed, this plan is a good alternative to those being offered that push us toward a system based on expansive government control, which will eventually lead to rationing, a reduction in quality of care, and increased health care spending. I still have some serious concerns about several elements of this plan, including the imposition of mandates; subsidies for higher income individuals; the impact on current market competition; the FDA labeling language regarding comparative effectiveness studies; and the issue of how to determine the appropriate level of coverage offered as part of a health care reform regime. However, it is important that Congress and the Administration work toward bipartisan solutions to this crisis that threatens the health care of millions of Americans.”

In other words, what Gregg supports is not the provisions of the bill but the fact of its bipartisanship. He supports the process but appears to oppose critical elements of the legislation. Or take this exchange Sen. Arlen Specter (D-Pa.) had on Meet the Press:

MR. GREGORY: Do you support taxing the value of, the value of employer-provided health care for workers?

SEN. SPECTER: No, I'd be very reluctant to do that. Health care provided by employers, which is deductible for them and not added on as income to the recipient, has been the mainstay of health coverage for millions of Americans, and I'd be very reluctant to abandon that.

MR. GREGORY: So the health care reform you would like to see is what?

SEN. SPECTER: I would, I would like to see all Americans covered. I've joined with the Wyden-Bennett plan, has 14 co-sponsors. I would like to see health care which emphasizes exercise and diet and, and makes premiums lower on that basis

The central financing feature of the Wyden-Bennett plan is that it ends, entirely, the tax break for employer-provided health care. I heard Sen. Bob Corker, the Republican from Tennessee, lavishly praise the bill at a press conference one morning. The next year, he dropped off as a co-sponsor.

It would be nice if there were seven Republican votes sitting ready to sign onto the Healthy Americans Act. That would make it an excellent potential compromise. But having followed this legislation for years now, I've seen no evidence of that fact. Instead, Republicans sign on with the caveat that they oppose the things the bill actually says it will do, but support the general idea that Republicans should be consulted on health care reform. Indeed, the lesson of the Healthy Americans Act, as I've seen it, has been that there are a lot of Republican votes for the appearance of being for something on health reform. But there aren't many Republican votes for actual health reform.

By Ezra Klein  |  June 24, 2009; 1:03 PM ET
Categories:  Health Reform For Beginners  
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Thanks for writing this. When I read Brooks' column yesterday, I was wondering why this wasn't under consideration. This explanation makes sense, and makes me question the intellectual honesty of Brooks' column. No Republican (and not enough Democrats) would sign up to a bill that ended deductibility of all employer-paid health insurance costs.

Posted by: swamus | June 24, 2009 1:09 PM | Report abuse

Do you think it's a better option than the recently released House bill?

Posted by: eRobin1 | June 24, 2009 1:11 PM | Report abuse

I find the singling out of health care as the one expense of a corporation that has to come out post-tax as completely bizarre.

THERE IS NO SUCH THING as an EMPLOYER tax break for health insurance costs, rather it is an EMPLOYEE tax break. These taxes would fall to the individuals receiving the benefits, not to the corporation making an expenditure. I am glad Specter has the sense to see this.

I also find the Republicans refusal to apply effectiveness guidelines to Medicare mindboggling. Why don't they want to cut the costs of Medicare? Is it just a votes thing? Are they afraid Democrates are trying to make them the bad guys and wanted to up their good guy credibility with the old racists and evangelicals that vote for them?

Posted by: staticvars | June 24, 2009 1:12 PM | Report abuse

I lean Republican on national economic policy more often than not, and I support 80% of Wyden-Bennett. I don't know the specific details of why each of the 7 GOP sponsors support Wyden-Bennett, but my best guess is that Mr. Klein is not giving their full reasons for supporting the bill. I like Wyden-Bennett because it is comprehensive; it eliminates the disparate tax treatment of health coverage; it raises real wages; it captures all of the best parts of the employer-based system (guaranteed issue, bargaining power, community rating) without the worst parts (cutting tie between consumer and insurance, underformed non-employer market due to adverse selection, portability). Wyden-Bennett is also universal; it can serve as the basis for solving Medicare's long run fiscal challenges; it empowers the private market while also making it more fair; and it encourages employment by no longer making employers responsible for paying for employees' coverage.

That said, here is my question: if Mr. Klein supports Wyden-Bennett over all other bills, why doesn't he focus on Wyden-Bennett, as opposed to his constant support for Kennedy-Dodd and its variations? It's not like Kennedy-Dodd has any GOP support either. So why not support the better bill, instead of the regular implorations that his readership support the public plan option?

Posted by: Dellis2 | June 24, 2009 3:58 PM | Report abuse

***** "if Mr. Klein supports Wyden-Bennett over all other bills, why doesn't he focus on Wyden-Bennett, as opposed to his constant support for Kennedy-Dodd and its variations? It's not like Kennedy-Dodd has any GOP support either." *****

Dellis2: I don't presume to answer for Klein, but it might have something to do with the fact that the admittedly smart Wyden bill has very little support among Democrats, either. There's simply next to no appetite among serious players for a complete repeal of the tax-exempt status of employer-paid health insurance premiums. Merely CAPPING said exemption is quite possibly non-feasible, politically...

Posted by: Jasper99 | June 24, 2009 7:00 PM | Report abuse

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