Craft a cost-wise compromise

McClatchy-Tribune Information ServicesJuly 30, 2009 

— OK, everyone take a deep breath. Everyone in Washington, that is. Now that we have a moment, let's rethink how to approach health care.

The Senate rightly decided to not rush a vote by the August recess. President Barack Obama wisely played statesman and accepted the slowdown. Players from the White House to Capitol Hill can search for a compromise.

As they do, they should return to the report last month from Democrat Tom Daschle and Republicans Bob Dole and Howard Baker. This respected trio, leaders of the Bipartisan Policy Center, outlined ways Congress could create a health care consensus.

Here are some basics:

Put a fee on employers with payrolls over $1 million if they don't offer employee health insurance.

Require individuals to buy insurance and insurers to cover them.

Give the states guidelines for creating public plans, but don't require a federal public plan.

Cap the tax subsidy that employers receive for covering employees and use that money to help struggling families afford insurance premiums.

Reward medical providers for quality of care, not quantity of services.

Those first three ideas form the basis of the compromise Washington needs. As Dole said, it was hard accepting mandates on employers and individuals, but it was a tradeoff. In return, Daschle accepted the state-based public plan, which is not the preferred route for congressional Democratic leaders.

The politics are still right to reach this kind of compromise, despite the House's rush to pass something before the recess. Conservative and moderate Democrats in both chambers increasingly worry about working proposals, including the federal public plan.

Some moderate Republicans are with them. They understand Obama's point that the economy cannot sustain the current rise in health costs, but they don't want to create an equally bad problem by approving reforms we couldn't afford.

Of course, the Democrats running Congress may believe they can get a bill purely with Democratic votes. Yet the president keeps saying he wants Republican support, and that's smart. If Congress passes a plan now with only center-left votes, a future Congress could overturn those reforms, depending how elections go. For Obama's legacy issue to endure, he needs a broadly backed bill.

The Dole-Daschle-Baker proposal has bipartisan written all over it, including the way it controls rising medical costs. Expenses have legislators spooked since the Congressional Budget Office said the House Democrats' plan would increase costs.

The former senators go after costs in several ways. For example, they would tackle the problem of gold-plated health plans by limiting how much employers can deduct for employee expenses. And they would change the way Washington pays providers. Today, Medicare reimburses doctors and hospitals for the services performed, not on whether the care was any good.

In a phone interview, Mark McClellan spelled out how some of these ideas would work, and he should know. A physician and economist, he headed Medicare under President George W. Bush and worked on health policies for President Bill Clinton. McClellan also worked with Baker, Dole and Daschle on their bipartisan approach.

McClellan argues the feds should move away from paying physicians for each service. Instead, they should pay in a way that rewards providers for preventing illnesses and treating patients better at lower costs. Simply squeezing doctors' Medicare payments, he says, is not the answer.

I'll stop with the wonkery here. The bipartisan approach offers political and medical sense. It will require both sides to give up something. But that's how grand compromises work. And with some deep breaths, that's what Washington can achieve.

William McKenzie is an editorial columnist for The Dallas Morning News.

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