Granite State Advice on Health Care Reform

Critics of President Bush often point out that he has asked very little in the way of sacrifice from most Americans during this time of war. Our troops abroad, our homeland security officials at home and the families of these brave individuals bear a huge burden while the rest of us are asked to go shopping and given tax cuts.

But whatever one’s view of Mr. Bush’s politics, it is also true that he was in part being responsive to a political environment in which shared sacrifice has gone out of style.

Something I attended last week gave me hope that this could begin to change. On Sept. 26, the Brookings Institution and St. Anselm College held an event in Manchester, N.H., focused on health care and the federal budget deficit as part of Brookings’ Opportunity 08 project.

As a policy generalist taking in the event, I was struck by the richness of the policy options presented. But even more, in keeping perhaps with the down-to-earth pragmatism and Granite State sensibilities of the people of New Hampshire, I was struck by how many of the panelists as well as audience members talked about what normal American citizens will have to do themselves. Politicians were not asked to do it all for us. Evocative of John Kennedy’s “ask not what your country can do for you, but what you can do for your country” line, the participants in the event described a number of sacrifices and efforts that regular citizens needed to make.

It was also no surprise, given the star of the event. Former Sen. Warren Rudman gave opening remarks and then moderated two panels of experts from Brookings and the New Hampshire Institute of Politics.

The panelists included former Bush administration health official Mark McClellan, Brookings economists Belle Sawhill and Henry Aaron, political experts Tom Donilon and Shep Melnick, Bob Bixby of the Concord Coalition (and Rudman’s co-author on a paper on long-term fiscal discipline that is a key part of the project), as well as St. Anselm scholars Jennifer Donahue and Jennnifer Lucas.

Among the ideas that were voiced in the course of this discussion were the following. Not all panelists endorsed each and every proposal, but together they provided a rich array of options for policy-makers as well as Americans in general to consider.

Americans need to eat better and exercise more. Obesity and poor physical conditioning cause major health problems, reduce productivity and drive up health care costs. What’s worse, they are becoming more prevalent.

Americans need to be helped to provide health insurance for themselves. This country will not have a European-style single provider or single payer system in the near future.

So we need to build on the strengths of our current system and recognize the fact that perhaps three-fourths of our fellow citizens are already generally happy with their health plans. That means reform should preserve what already works while helping those who now lack insurance to gain access to the system.

This approach might involve reducing the tax exemption that most of us get today, through our employers, for health insurance. Such exemptions might be capped, giving the federal government more revenue. That added revenue could be used in turn to help those of limited means to purchase insurance (more a Republican approach) or to fund state programs to cover more uninsured children directly (more a Democratic idea) or some combination of the two.

Although not directly related to health care, Americans might be encouraged to work longer through modest changes to the social security system. This would help our fiscal picture. And there actually may be indirect health benefits, if in working longer people also stay active longer.

States should be encouraged to keep experimenting with new ways of providing insurance coverage to a greater fraction of their populations. Rather than look for the perfect federal solution, we might return to the concept of states as the great laboratories of democracy, see what works and gradually hope good ideas spread around.

As Senator Rudman concluded, there may be the possibility of major progress on health care legislation in 2009. If candidates are armed with ideas like the above, we could be in for a very exciting first 100 days of the new presidency, whoever wins next November.