Summit strategy

Sunday, February 21, 2010

PRESIDENT OBAMA plans to unveil, in advance of Thursday's health-care summit, a merged version of the House and Senate bills. Whether this is the right approach depends on the product. In particular, the Obama blueprint needs to retain two imperfect but important efforts to control costs: an independent commission empowered to recommend changes to Medicare, subject to an up-or-down congressional vote, and an excise tax on high-cost insurance plans.

The blueprint also would have to withstand the legislative process, and on that score there are disturbing signs. Sen. Kent Conrad (D-N.D.), who supports the tax, told The New York Times that the outlook for it was "very cloudy." House Speaker Nancy Pelosi (D-Calif.) was even blunter: "The excise tax has no support, very little support, in our caucus." The administration has been bemoaning, as recently as Saturday, spikes in insurance premiums. But without mechanisms such as the excise tax to discipline costs, premiums will continue to rise even if health-care reform passes. The White House has to make that case.

The White House's approach might well require the use of the tool known as "reconciliation," under which the Senate can proceed by majority vote, rather than by 60 votes in favor. This mechanism is provided for under Senate rules and has been used to pass important measures such as welfare reform. In terms of ensuring a fair process, there is nothing wrong with it.

But is it wise to deal with a subject as sweeping -- and controversial -- as health reform with support from just one party? A more modest measure might garner broader political and popular support. It could cherry-pick some of the best parts of health reform: the independent commission; expanding Medicaid; allowing children to stay on their parents' insurance plans until age 26; encouraging state or regional exchanges for individuals to buy coverage; establishing pilot programs to change the way health professionals are reimbursed.

The argument for comprehensiveness is that the pieces of health reform are interconnected. Prohibiting insurance companies from denying coverage because of preexisting conditions is enormously popular. But, if not coupled with a requirement that everyone obtain insurance -- which requires the far less popular individual mandate -- such a prohibition would result in higher premiums.

Ideally, then, a more encompassing approach -- one that takes serious steps toward controlling costs and expanding coverage -- would be preferable. Under current circumstances, given the rising debt and public anxiety about health reform, a less ambitious measure that brings along a reasonable number of Republican lawmakers shouldn't be ruled out. Demonstrating that Washington can tackle a serious problem and reach some degree of bipartisan agreement would be good for the nation's health, not just its health care.

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