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Can There Be a Good Compromise on Health-Care Reform?

Earlier this week, Oregon's Ron Wyden and Utah's Bob Bennett co-authored an op-ed for The Washington Post arguing that the Healthy Americans Act represents a bipartisan path forward for health-care reform. But they weren't the only ones. Along for the ride were Sens. Debbie Stabenow (D-Mich.), Ted Kaufman (D-Del.), Daniel K. Inouye (D-Hawaii), Mary Landrieu (D-La.), Joseph I. Lieberman (I-Conn.), Bill Nelson (D-Fla.), Judd Gregg (R-N.H.), Michael D. Crapo (R-Idaho), Lindsey O. Graham (R-S.C.) and Lamar Alexander (R-Tenn.).

If you're keeping count, that's five Republicans and seven Democrats. Notably absent were Maria Cantwell, Jeff Merkley and Arlen Specter. All three are co-sponsors of the bill, but none want to step in front of Max Baucus's process right now or be seen advocating an alternative to the process that the White House has developed. Still, that's 12 senators on one op-ed arguing for one thing. It's a pretty impressive achievement.

The Wyden-Bennett process is what bipartisanship should look like but doesn't. Too often, bipartisanship takes the form of the final days of the stimulus bill, or the current co-op compromise: Rather than combining the differing insights of both sides to make a bill better, it simply makes a bill smaller, and less likely to achieve its desired impact. That isn't the union of differing approaches. It's the purchase of a few cross-aisle votes.

The Healthy Americans Act is the other type of bipartisanship. The presence of Republicans and Democrats has made for a more, rather than less, ambitious bill. The liberals want to end employer-controlled health care. They want radical integration of the health-care system. Totally universal coverage. Broad subsidies. Conservatives have brought an emphasis on developing a working market. An understanding that people should understand the full cost of their health-care insurance. Both sides have been serious about cost control. It has some real problems in how it structures its subsidies, but it is, in the aggregate, much better than anything we are likely to get. It's like single-payer delivered by the market.

The Healthy Americans Act, however, is not viable at this point. It's much more radical than anything on the table. It's loathed by unions and rejected by most conservatives. It would change the insurance that almost everybody has, whether they like it or not. It's very good policy. But you have to pass legislation through the Senate you have, not the Senate you want.

And in the Senate we have, the Healthy Americans Act was never actually embraced by a solid bloc of senators. The co-sponsors praised the process but didn't commit to voting for the bill. The Republicans did not throw real support behind the framework. Chuck Grassley signed on as a co-sponsor and then dropped off when the real action began. It never had sufficient support to become a real vehicle for health-care reform. The bill is bipartisan enough to be interesting, but not bipartisan enough to pass.

In the end, the arc of the Healthy Americans Act shows two things. The first is that we could have a better Senate than we do, a Senate in which members of both parties try to unite their insights into good and ambitious policy. The second is that even if the beginnings of that Senate can be glimpsed in this or that process, it is not yet the Senate that emerges when there is actual legislation to be passed. If things were different, Wyden-Bennett would be a good alternative. But the argument that needs to be made is not that Wyden-Bennett is a good alternative. It's that things are different.

As of yet, there's not much evidence of that. I'm still of the opinion that the bill's co-sponsors would do better getting behind Wyden's Free Choice amendment, which could add some of the Healthy American Act's best features to the other health-care reform bills. That would be a compromise from the ambition of the Healthy American's Act, of course. But this is a group that believes in the value of good compromises.

By Ezra Klein  |  August 7, 2009; 10:54 AM ET
Categories:  Health Reform  
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Next: When Steve Pearlstein Stops Being Polite and Starts Getting Real


I feel like it can't be emphasized enough that the Republican co-sponsors of the bill by and large would never vote for it. Has anyone even asked them if they would?

Posted by: Drew_Miller_Hates_IDs_That_Dont_Allow_Spaces | August 7, 2009 11:10 AM | Report abuse

From what you are saying, and from what can be discerned Wyden has been shut out of negotiations to this point. But I agree, the "Free Choice" Amendment would shift the whole debate. Americans like individual choice, on both the left and the right. It would be tantamount to something like a health care voucher.

Posted by: cmpnwtr | August 7, 2009 11:13 AM | Report abuse

Everyone always says the Healthy Americans Act isn't politically viable. But I'm a bit unsure about what this means. What if Obama throws his weight behind it? Would he really be unable to get enough Democratic votes? After all, he only needs to get 45 out of 60 (and 55 Democrats to forgo filibustering). If he really can't get these votes, then certainly it's not viable.

But otherwise it's only not viable because Obama doesn't want it, which seems to me to be quite a different thing.

Posted by: clifton_ealy | August 7, 2009 11:24 AM | Report abuse

I think what is interesting is that Wyden-Bennett probably has a better chance of passing in a good, competent Republican administration (think Romney) than it does in a a good, competent Democratic administration, due to insulation from influence of the unions.

The basic, killer problem with Wyden-Bennett is that the unions are dead-set against it, and having already lost EFCA, they are quite loth to compromise in anything further. But then, the unions have never really been into compromising and qui pro quo.

Posted by: jvriebeeck | August 7, 2009 11:56 AM | Report abuse

The posting about the "Healthy Americans Act" is the most articulate and profound description of the state of play of the health care discussions and the absolute disgrace in what can now, only laughingly, be described as the "World's Greatest Deliberative Body." In general, the ladies and gentlemen who now populate the Senate should be ashamed of themselves. The House is in worse shape.

Can't we start from scratch? Soon? Lest it be too late. As I enter the twilight of my life, I am appalled at the lack of civility and candor which has permeated the political process in the last 30 years, give or take.

Posted by: jgrecco | August 7, 2009 12:17 PM | Report abuse

The problem with the wyden bill is not unions. It is all Americans. You literally tell every single person that the government is going to make them change their insurance. You think Medicare for All is a hard sell. This one is pure insanity.

Posted by: JonWa | August 7, 2009 1:21 PM | Report abuse

I don't question the sincerity of Wyden (and maybe Bennett), but my more cynical view is that the other sponsors are only listed as sponsors because they want to be able to say they were for a better bill than whatever emerges from the final conference committee - which they will all vote against.

The GOP couldn't or wouldn't produce a viable alternative to the process underway in the House and Senate, so Wyden/Bennett is the cover story for their no votes. It is a sham.

Wyden should have realized months ago that if he and his key features were to have relevance to the final bill, he needed to give up the separate bill and join into the committee process to make things better. As it is, all he's doing is providing cover for nay-sayers who wouldn't vote for the bill they co-sponsor, and hate the very idea of having to nakedly vote no on the conference report bill without some cover.

Posted by: JimPortlandOR | August 7, 2009 1:22 PM | Report abuse

"I think what is interesting is that Wyden-Bennett probably has a better chance of passing in a good, competent Republican administration (think Romney) than it does in a a good, competent Democratic administration, due to insulation from influence of the unions."

I am not a conservative or a Republican, but I have to think there's a lot of provisions in Wyden-Bennett that would be unpalatable to the conservative base - an individual mandate, standardization of benefits, community rating, progessive subsidies, etc. This is a sampling of conservative reaction to Wyden-Bennett:

Posted by: PeterH1 | August 7, 2009 1:26 PM | Report abuse

I think you are missing some of the second-order strategy involved in supporting this bill that commenters are pointing out. I think you are assuming a sincerity from these supporters that may not necessarily be there when it comes time to vote for a health reform bill that restructures the health insurance and/or healthcare system

Posted by: michaelterra | August 7, 2009 2:43 PM | Report abuse

Forgive my ignorance on the issue (I haven't been following it as closely as I should have), but wouldn't the Wyden-Bennett bill have a lot more momentum going for it right now if President Obama had gotten behind it from the very beginning, touting it as the best alternative out there, a real solution to our health-care crisis, etc. etc. I suppose the response the president would give is that it sounds nice, but would never pass the Senate. But isn't that sort of like Kent Conrad saying there can't be a public option because it wouldn't pass the Senate? Why not at least try, right? So what was the president's aversion to the Wyden bill? I don't get it...

Posted by: jmoisica | August 7, 2009 2:58 PM | Report abuse

I agree on a lot of this, but...

"The liberals want to end employer-controlled health care."

I think its more accurate to give the Republicans credit for this one. You'd be pretty hard-pressed to name one prominent Dem that has made this a central part of their platform. This was one of the key pieces of McCain's reform package. Just yesterday, Krauthammer said that this was only one of two things he'd want to change about the system. I'm not aware of anyone on the left that's made this a priority.

Posted by: wisewon | August 7, 2009 3:34 PM | Report abuse

From the article/proposal:

"Most have agreed to require employers to contribute to the system and to pay workers wages equal to the amount the employer now contributes for health care."

That's a tax, folks - one that presumably would fall largely on workers earning less than $250,000. Employers don't pay for (health) benefits but with money that otherwise would be available for wages.

Would Dems be honest about the fact that this is a tax increase on workers, not employers? And would Obama break his no-tax pledge?

Posted by: tbass1 | August 7, 2009 4:47 PM | Report abuse

The idea of choice is a red herring. I am 71. I have Medicare. I want a choice of doctor; I got it. I want a choice of medical treatment; I got it. I never had either under private insurance. I do NOT want a choice of insurance. Medicare is fine for me. We should give it to everyone. It is so much more efficient than private insurance, it will cost us no more than we are now paying to give it to everyone.

We don't have a choice of fire departments, do we?

Posted by: lensch | August 7, 2009 5:05 PM | Report abuse

jmoisica unions helped elect Obama and they are dead set against ending/changing the employer tax exclusion, under the plan benefits greater than what members of congress now receive (adjusted for inflation of course) would be taxed everyone else would get a credit.

I'm guessing the indexing of the plan to the economy would not harm the poor - for 10 years costs are projected down with the plan, during that time various micro reforms are going into effect or tried IT investment, cost effective pay for performance care and you'd need a lot of extensive new supplemental spending to restart medical inflation.

Posted by: DougHuffman | August 8, 2009 5:51 AM | Report abuse

I think whether the Wyden-Bennett sponsors also support the Free Choice Amendment will be a good metric of whether they were serious about the bill in the first place.

Posted by: zosima | August 10, 2009 3:08 AM | Report abuse

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