The 'Rock' In Health Reform
The goal of the Obama White House is to come up with a health-care plan that can attract bipartisan support. The president has told visitors that he would rather have 70 votes in the Senate for a bill that gives him 85 percent of what he wants rather than a 100 percent satisfactory bill that passes 52 to 48.
There is good reason for that preference. When you are changing the way one-sixth of the American economy is organized and altering life for patients, doctors, hospitals and insurers, you need that kind of a strong launch if the result is to survive the inevitable vagaries of the shakedown period.
But getting agreement from Democrats and Republicans on such a volatile issue will not be easy. Republicans and their business allies killed the Clinton administration's effort at health-care reform. And even the optimists in the White House acknowledge privately that it will be hard to collect more than a handful of GOP votes in the House, where most of their efforts focus on negotiating agreements between liberal and conservative Democrats.
The two senators who can speak with the greatest authority on framing a bipartisan health-care bill are Ron Wyden, an Oregon Democrat, and Bob Bennett, a Utah Republican.
In the last Congress, Bennett, a staunch conservative, delighted the more liberal Wyden by volunteering to become the lead co-sponsor of Wyden's Healthy Americans Act.
Together, they rounded up the largest bipartisan sponsorship of any major health-care bill -- eight Democrats and six Republicans, among them three members of the GOP Senate leadership.
Their bill -- in the simplest terms -- would have guaranteed portable, affordable health insurance to every American. It would have required individuals to purchase private health-care policies, with subsidies as needed from employers and government. Most remarkably, the sponsors obtained an estimate from the Congressional Budget Office and independent auditors that their plan would be self-financing after a short transition period and might save a trillion dollars over 10 years.
When I asked Wyden and Bennett in separate interviews this week how Obama might assemble bipartisan support for any health plan, they both said the key would be to find a plausible way to control its costs.
As Wyden put it, "The country is worried about the amount of debt we're piling up; you hear it in town meetings and see it in the polls. . . . That's why we have to show this is affordable."
Obama has recognized that need and has offered some tentative ideas for offsetting the costs of covering the 46 million uninsured. But the issue will not really be joined until specific legislation emerges -- and is scored by the Congressional Budget Office.
Meantime, there is a preliminary but intense debate about whether a government-sponsored insurance plan should be made an option for people choosing from a menu of health-care coverage options. Liberals want that included. Staffers for Sen. Ted Kennedy (D-Mass.) included it in the draft legislation they rolled out last week. And Obama has reiterated his support for it.
But this week, the Republican members of the Senate Finance Committee, where a bill will be written this month, said almost unanimously that the government plan was a nonstarter.
Bennett, who is not on the committee, underlined that determination, telling me "we will fight almost to the last man and woman against a government-run plan, and not a few Democrats will join us."
Wyden, careful to preserve his credentials within his own party, said he saw this fight as more of a broad philosophical debate about the role and scope of government, but he reminded me that his bill last year did not include a government-sponsored plan.
The time may come -- either before or after the House votes on its bill -- when Obama may have to demonstrate his flexibility on the issue of a government-run option. Wyden and Bennett are potential allies if he removes what Bennett calls "the rock" blocking a bipartisan bill. And the president couldn't wish for better partners.