A Bipartisan Attempt to Break the Health-reform Stalemate

Henry J. Aaron and
Henry J. Aaron The Bruce and Virginia MacLaury Chair, Senior Fellow Emeritus - Economic Studies

Stuart M. Butler

January 1, 2007

Heated bickering and bitter partisanship marked the ’06 campaign trail. But something quite different—and far more hopeful—was happening quietly on Capitol Hill: Bipartisan groups of House and Senate members joined together to support bills that make a serious effort to help the nearly 50 million Americans who lack health insurance.

Now that the elections have returned us to divided government, that bipartisan approach just might produce real progress.

The lawmakers spearheading the bipartisan drive for health reform are no centrists. They span the ideological spectrum. For example, lead sponsors of HR 5864 are Rep. Tammy Baldwin, D-Wis., and Tom Price, R-Ga. The National Journal rates Baldwin among the 10 percent most liberal House members and Price as one of the 20 percent most conservative. The bill’s 35 co-sponsors are equally divided in their views.

These members disagree strongly about how to extend insurance coverage. Some favor a Canadian-style ”single payer” system. Others want expanded health savings accounts. Still others would require employers to either sponsor employee health plans or pay a tax penalty.

What brings ideologically diverse lawmakers together on the Baldwin-Price bill? It’s the same thing that unites senators behind a similar bill, S 2772, introduced by Sens. George Voinovich, R-Ohio, and Jeff Bingaman, D-N.M. And it’s what drove us—two ”think tank” analysts with very different views about health reform—to develop the approach encapsulated in these bills: an overriding desire to fix the problem.

Rather than perpetuate the fruitless debate that has persisted for decades, we all favor trying a variety of ideas to see which works. And we accept that one idea might work better in Texas and another in Vermont.

It’s a ”let a thousand flowers bloom” approach. Under the Baldwin-Price bill, any state could propose a solution to improve coverage within its borders. The proposals could involve radical changes to federal, as well as state, health programs. One state might seek to spend federal money more effectively. Another might let private-sector families join the federal employee health program. Yet another might create federal-state tax credits or vouchers to help people buy insurance.

Each plan would have to include clear, measurable goals for improving coverage over a five-year period. And each would have to specify the bottom line costs for the federal government.

A special bipartisan commission—staffed by the Health and Human Services secretary, mayors, governors and members picked by congressional leaders—would review the state proposals and select a ”slate” spanning the ideological range.

This slate would go to Congress for an up-or-down vote with no amendments—all or nothing—with rules to prevent stonewalling and political micromanagement. If chosen, a state plan would last for five years. It would get a share of however much money Congress voted for the program, based on state progress in reaching its goals.

The bill makes political sense because all proponents—right, left and center—would have the chance of seeing their ideas tried out as part of an agreed slate. Liberals and conservatives alike should know that congressional polarization and gridlock today means that their pet ideas will not make it through Congress alone. As part of a commission slate, however, both would see their ideas tried, and get a fair test.

Tammy Baldwin does not think Price’s consumer choice ideas will work. Tom Price thinks Baldwin’s affection for single-payer health care is a big mistake. But each can support a bill that lets both ideas be tried and compared. So can the other liberal and conservative co-sponsors.

The assurance that competing ideas from both sides get tried is one key ingredient of the bill. Another is the recognition that long-term answers on health coverage will come from the bottom up, not the top down. Rather than continue the fruitless effort to find a single approach that can win national approval, the Baldwin-Price bill would simply set broad goals and then invite the states to devise ways to reach those goals.

Against the prevailing background of poisonous, partisan bickering, there is something very heartening about a group of ideologically diverse members willing to work together, willing to respect each other and allow each other’s ideas to be tested, and willing to accept that the best ideas to fix health care are likely to come from outside Washington.

Divided government requires bipartisan action to get serious progress on tough issues. If Tammy Baldwin and Tom Price and their co-sponsors can succeed on health, perhaps bipartisan collaboration can be saved from extinction. Then maybe, just maybe, we can get some things done.