(Opinion) As Republicans and Democrats stake starker positions on the future of health care, they have an opportunity for a grand compromise that resets how we make laws in this country.
Senate Democrats, led by Bernie Sanders of Vermont, have proposed a single-payer “Medicare For All” law that would have the federal government insure all Americans’ care with private doctors the way it currently does for all citizens over 65.
Senate Republicans, led by Lindsay Graham of South Carolina and Bill Cassidy of Louisiana, have proposed a last-ditch effort to eliminate Obamacare (aka the Affordable Care Act) by handing states health care block grants and eliminating individual, employer and coverage mandates.
The proposals represent two conflicting philosophies about how best to deliver better health care at a lower cost: One by replacing the insurance industry with the government and including everyone in one large pool with guaranteed care; the other by freeing states and private industry to innovate.
Given the current partisan stalemate in Washington — and in the country — it would seem impossible to see the first proposal become law anytime soon. The prospects for the second seem dim, too.
But what if they both become law?
What if, instead of fighting, the two sides agree to a law that permits blue states to form a compact to deliver a single-payer system for the half of the country that wants it, and red states to run with the block-grant system?
Passing such a compromise would involve ironing out crucial details, of course. Most have to do with money: While advocates of both systems argue that they will eventually lower costs, up front they will need more money to succeed.
And the health care industry would fight the proposal to the death.
So will ideologues who want to make sure their side “wins” every battle in Washington instead of allowing all ideas to compete in the marketplace. Even conservative Republicans who claim they stand for states’ rights to experiment and set their own policy: This week U.S. John Kennedy of Louisana sought to make sure the Graham bill will forbid states from trying out single-payer.
But consider the winners in a true compromise that allows blue and red states to pursue their visions: Republican lawmakers would be able to claim that they eliminated Obamacare as promised. Democrats would be able to claim that they expanded and improved upon Obamacare as promised. President Trump — who evinced a fleeting sympathy for “Medicare for All” on the campaign trail while vowing to kill Obamacare — would have not just a major legislative victory, but also a basis to claim that he could break a generation-old logjam. Much the way he may end up winning credit for pushing Congress to legislate a bipartisan solution on immigration.
We’d find out which side is right about how best to deliver health care and have the United States catch up with other Western countries in both outcomes and cost controls. Most likely, we’d find out how to tinker both proposals to make them live up to their backers’ goals.
Best of all, the fear of paying for getting sick would plague fewer and fewer families and businesses across the country.
If Republicans and Democrats seize this moment to strike a grand bargain on health care, who knows what else they can accomplish?
Paul, this is the insurance equivalent of letting states decide whether people should drive on the left or right side of the road. It would impose real economic costs by discouraging geographic mobility. Let's say you're in a single payer state with a pre-existing condition. You would be unlikely to take a job in a non single payer state, even if that job was a better fit for you and paid more.
One of the first things I learned at the Capitol is that the current legislature cannot bind a future legislature. The primary reason the individual health plan market is in trouble in much of the country is uncertainty as to the rules that will apply to the industry. Your proposal would seriously exacerbate this problem.