Is Bipartisan Health Care Reform Possible?

The following took place in an online discussion that asked, is bipartisan cooperation on health care reform possible? If so, what would it look like?

Under current political circumstances, the answer to the first question is no; if it was affirmative, the answer to the second question would be a legislative package that looked pretty much like the bills already passed by the House and Senate but with a stronger dose of malpractice reform and leavening from Wyden-Bennett — the Healthy Americans Act; introduced by Democratic Sen. Ron Wyden and Republican Sen. Robert Bennett. Let me explain.

There was and is no market among Republicans for bipartisan cooperation on health reform with President Obama in the White House and Democrats in control of Congress. Before Obama was inaugurated, Republican congressional leaders made a strategic calculation that the best route to reclaim the majority in Congress was to unify in opposition to all of Obama’s major initiatives, using the Senate filibuster whenever possible to kill those initiatives, speaking in harmony to discredit the product when it is not. Their political success to date has been impressive.

A parliamentary-like minority party working under a set of congressional rules (most importantly the supermajority hurdle imposed by the Senate filibuster) is a potentially potent force, especially given the enormity of our problems following the economic collapse and financial crisis and the unpopularity of measures needed to cope with them. Republicans have no political incentive to reverse course now; and the seven Republican senators whose co-sponsorship of the Wyden-Bennett bill in the last and/or current Congress made them natural participants in serious bipartisan negotiations have no political space within their party to do so. Overtures by Obama have repeatedly fallen on deaf Republican ears. If health reform passes this year, it will be with Democratic votes alone on a separate reconciliation bill incorporating changes in the bill that has already cleared the Senate.

If bipartisan cooperation depended only upon the election results and policy views of President Obama and members of Congress, a package is not hard to identify. The base bill would be a Democratic version because they won the last two elections big time and their approach reflected a pretty broad consensus in the policy community and among many of the key stakeholders. Markups in both chambers produced bills that used moderate means to achieve ambitious objectives; they relied mostly on private insurance and resembled approaches championed by some Republicans in 1993-1994 as alternatives to the Clinton health reform plan.

A commitment by a half dozen or so Senate Republicans together with a comparable segment of Republicans in the House to support the final product could have produced a bill that was more ambitious in reforming malpractice litigation and in empowering more individuals to shop for their own health insurance. One example of an effort to blend the Obama-Baucus and Wyden-Bennett approaches can be found here.

But in this era of polarized parties, a routinization of the filibuster, and the permanent campaign, it was not to be. If health reform becomes law anytime soon, it will be a moderate reform but perforce an all-Democratic one.