Network News

X My Profile
View More Activity

Should Health Care Reform Be Bipartisan?

obama_mcconnell.jpg

David Broder has a column today talking up the Wyden-Bennett bill and the importance of bipartisanship in health reform. He quotes Sen. Bob Bennett (R-Utah), saying, "we will fight almost to the last man and woman against a government-run plan." This comes on the heels of a Post editorial calling Obama's support for a public plan "disappointing," as it would "doom what Mr. Obama says are his hopes for a bipartisan agreement."

Fair enough. There's an obvious logic to bipartisanship, particularly when you're pursuing large reforms in a closely divided republic. But I'd like to see some transparent calculations about the worth of bipartisanship. The question of Republican votes, after all, isn't whether they are, all else being equal, a good thing. It's whether they're worth the tradeoffs necessary to attain them.

Broder and the Post editorial board focus other portions of their arguments on the importance of cost controls, for instance. So it would be interesting to see them explain how many Republican votes you have to gain to justify losing a policy that would lower the costs of health insurance by nine percent a year, as the Lewin Group estimated a "level-playing field" public plan would do. And how many Republican votes are worth sacrificing a policy that would lower the cost of health insurance by between 20 percent and 30 percent a year, as the Commonwealth Fund estimated a "strong" public plan would do?

And it's not just the public plan. Republicans have grave concerns about the cost of health reform. Much of that cost comes from the subsidies that help low-income Americans afford health insurance. Are 10 Republican votes worth lowering the subsidies from 400 percent of poverty to 300 percent of poverty and leaving out, say, eight million Americans? Are five Republican votes worth leaving out eight million Americans? Two Republican votes? It would be nice if someone published a table or something.

(Photo credit: AP Photo/Charles Dharapak)

By Ezra Klein  |  June 11, 2009; 10:41 AM ET
Categories:  Health Reform  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: Newspapers and Blogs, Working Together
Next: Is the Obama Administration Getting Serious About Executive Compensation? (No.)

Comments

Well-said, thank you. The Republican objections (which are shared by some Democrats) have nothing to do with cost concerns and everything to do with serving the insurance industry with its huge stake in preserving the current inefficiencies.

Posted by: csdiego | June 11, 2009 10:52 AM | Report abuse

Of course, ideally, every Senator would be on board for a real health reform policy that is not only universal but sustainable.

Realistically though, there is political advantage in opting for the most expensive, least tax-payer and consumer friendly option.

That's part of the tension in any compromise.

Broder's position is predictable. So in some sense is the position of the editorial board given it's tendency to favor establishment interests on K Street over that of ordinary voters.

Posted by: JPRS | June 11, 2009 10:59 AM | Report abuse

Should it be bipartisan? yes. Can it be? doubt it, especially given the flavor of Bennett's comments.

We have had many bills in the past...Republican and Democratic alike....that ended up getting passed that were not bipartisan. That is the way the process works. Feels bad to the minority party, but it is what it is. In the end the majority party makes a stand for something they strongly believe is right, the President can sign or veto, and the people can vote the bums out of office if they like.

My concern is ultimately JPRS's....are we concerned about healthcare costs or saving the insurance industry? I don't think we should blow away the insurance industry....it is an important part of the economy....but we can't overly pander to them either.

Posted by: scott1959 | June 11, 2009 11:07 AM | Report abuse

Bi-partisanship is just another term for political cover. The Dems won't ram through something like health care because if the plan doesn't work, they would get killed on it. They're gutless.

Posted by: SteveCA1 | June 11, 2009 11:21 AM | Report abuse

I agree completely with your points. Bipartisanship in a two-party political system just maintains the status quo. Any bill that can get 60 or more votes in the Senate probably isn't worth passing

Posted by: marvyT | June 11, 2009 11:24 AM | Report abuse

Given the Republicans' obvious preference for maintaining the status quo, I wouldn't try very hard to get their votes.

Posted by: tl_houston | June 11, 2009 11:36 AM | Report abuse

Sometimes you just have to take big risks. A robust public plan may cause bunches of conservatives to kvetch, but they're not likely to retake one or both houses of congress for several years. In the mean time, millions of voters will enroll in the public plan and become comfortable with their new status quo. By the time Republicans take back control of congress it'll be tough to take healthcare away from that many people.

Posted by: MosBen | June 11, 2009 11:52 AM | Report abuse

This is a philosophical question concerning to what degree sound public policy should be compromised to advance political goals. My personal view is that public policy should rarely be worsened solely for political reasons.

That said, I still have a fundamental disagreement with Mr. Klein on why non-employer private health insurance is so inadequate. Mr. Klein believes that there is a general disparate knowledge problem with private plans, and that these plans greedily exploit their superior knowledge to hurt their customers.

I disagree with this view. In my opinion, the private market is inadequate because of the market failure of adverse selection, which is largely caused by the employer-only health insurance deduction.

Either way, I do think any eventual health care reform could benefit from Republican-based ideas on the merits. These ideas include: eliminating the bias towards employer-only insurance; medical malpractice reform by replacing juries with expert finders of fact and capping awards; expanding consumer choice; and making the process more consumer-driven by increasing co-pays, premiums, and deductibles.

Posted by: Dellis2 | June 11, 2009 12:05 PM | Report abuse

Broder's calls for bipartisanship have become so reflexive that they have reached the point of tedium. They are a means in search of an end, which is a pretty dumb way to craft legislation.

Posted by: newjersey_lawyer | June 11, 2009 12:06 PM | Report abuse

Dellis2....I think you make some good points. I think the failure of the private market is one of lack of standardization (which does create understanding issues for consumers) and cherry picking. Insurers call it fear of adverse selection...fair enough. But their reaction is to cherry pick through underwriting and application of pre-existing conditions rules. Those are things we need to legislate away.

I am hopeful that the Republican ideas you mention are part of reform. All indications are they will be. I personally think that alone is not enough, but needs to be a part.

Posted by: scott1959 | June 11, 2009 1:20 PM | Report abuse

Scott: I completely agree with your comment. I agree that cherrypicking is a serious public policy concern because it limits health insurance access for the under-employed non-seniors. I do think that we cannot eliminate cherrypicking unless we impose a mandate, because otherwise we've simply exacerbated the already-existing adverse selection market failure.

In other words, we need to force the young/healthy to subsidize the old/unhealthy. Given this unfortunate truth, we should also focus on helping young workers more, through actions like curtailing the payroll tax to lower the costs of employing entry level workers; ensuring that homes continue to decline in value commensurate with per capita income so that starter families can afford starter homes again; and limiting the deductiblity and tax exempt status of universities, as well as binding early admission, to ensure that endowments are spent on current students so that tuitions will stop skyrocketing.

Posted by: Dellis2 | June 11, 2009 1:51 PM | Report abuse

"we will fight almost to the last man and woman against a government-run plan."

This is a funny phrase in the context. Bennett must know that, given the party split in the Senate, they have to fight to the _first_ man or woman. After that, they've pretty much lost.

Posted by: AronB | June 11, 2009 2:52 PM | Report abuse

Did Ezra link to the right Lewin study? He writes:
"So it would be interesting to see them explain how many Republican votes you have to gain to justify losing a policy that would lower the costs of health insurance by nine percent a year, as the Lewin Group estimated a "level-playing field" public plan would do."
I find nothing in the Lewin study he then links to that could support such a claim.

Is he just making stuff up?

Posted by: conn_carroll | June 11, 2009 3:08 PM | Report abuse

Read it again. Bottom of page 5:

"the program could be implemented using private payer rates (i.e., “negotiated”
rates). Under this scenario, premiums would be only about 9 percent less than in private plans, reflecting that the program would still have lower levels of administrative costs than private insurance."

Posted by: Ezra Klein | June 11, 2009 3:37 PM | Report abuse

Very well done, Ezra. Here in Oregon we're scratching our heads at the way Senator Wyden seems to be working as a passive front for Republican efforts to stymie meaningful reform. I'm covering the issue at LoadedOrygun.net, (http://www.loadedorygun.net/diary/1831/ezra-distillates-wyden-broder-what-price-bipartisanship-on-health-care) and am reminded of Don Francis advocating for blood bank testing for HIV in the film And the Band Played On: "How many dead hemophiliacs do you need?"

Posted by: torridjoe | June 11, 2009 5:09 PM | Report abuse

Yes, I thought that might be the passage you were referring to. So let's compare the two. Ezra writes:
"a policy that would lower the costs of health insurance by nine percent a year, as the Lewin Group estimated a "level-playing field" public plan would do."

The Lewin study actually says:
"Under [the negotiated rates] scenario, premiums would be only about 9 percent less than in private plans, reflecting that the program would still have lower levels of administrative costs than private insurance."

Now maybe I'm misreading Ezra's first sentence but it sounds to me like he's saying Lewin says a weak/level playing field plan will cause all health insurance premiums to drop 9% per year. The Lewin study says no such thing.

The Lewin study simply estimates that the premiums for the weak public plan would be 9% lower than private plans. A far different statement.

Again, maybe I'm just totally misreading Ezra's characterization of what the Lewin plan says. But if so, his sentence is highly misleading.

Posted by: conn_carroll | June 12, 2009 10:47 AM | Report abuse

Mr Klien,

The question is NOT should it be bi-partisan ... the question is can it survive NOT being bi-partisan.

All you need to figure out the difference is to repeat to yourself ...

"What is passed via budget reconciliation CAN and WILL be canceled via budget reconciliation. Can we TRUST the American people not to have another 2004 moment in 2012?"

Posted by: chromenhawk | June 13, 2009 4:29 AM | Report abuse

The comments to this entry are closed.

 
 
RSS Feed
Subscribe to The Post

© 2010 The Washington Post Company