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To Dream The (Im)Possible Health Care Reform Dream

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Donk Quixote and Phanto

This is a joint post of Justin Gardner (Donk Quixote) and Mike Wallach (Phanto), wherein they endeavor to tilt at windmills (with many apologies to Miguel de Cervantes):

“And no sooner did Donk Quixote see them that he said to his squire, “Fortune is guiding our affairs better than we ourselves could have wished. Do you see over yonder, friend Phanto, the hulking healthcare insurance giants? I intend to do battle with them and slay them. With their spoils we shall begin to have healthcare for all, for this is a righteous war and the removal of so foul a brood from off the face of the earth is a service God will bless.”

“What giants?” asked Phanto.

“Those you see over there,” replied the blogmaster. “With their long corporate arms. Some of them have arms well nigh two leagues in length.”

“Take care, sir,” cried Phanto. “Those over there are not giants but bureaucrats and political windbags. Those things that seem to be their arms are purses which, when they are filled with contributions, weigh heavily on the laws that control our lives.”

Those familiar with Justin and Mike from reading this blog, know that we are generally at odds, disagreeing more than we agree. Justin is a registered Democrat, and considers himself a liberal with independent leanings. Mike most recently registered as a Republican, but considers himself primarily a fiscal conservative, deficit hawk, and a libertarian leaning independent.

But lo and behold: We found common ground in the Health Care Reform debate.

If we were starting with a blank slate, we would support vastly different and incompatible health care systems. But we are not starting there. We have different objections to the existing system, but agree that the current system is in need of reform. We also agree that the reform most Americans want includes three critical criteria:

  1. Universal coverage for all Americans
  2. Insurance against financial ruin if struck with an illness.
  3. The reform program be fiscally responsible, manageable and have understandable costs.

What currently existing bill hits all three?

Wyden-Bennett.

Yes, we both support (S-391) The Healthy Americans Act and agree it represents a good foundation on which to build rational Health Care reform.

Donk Quixote (JG):

“Wyden-Bennett has my support because it does away with the pre-existing condition clause, reigns in costs and has the potential to cover more Americans than the current legislation being proposed.”

Phanto (mw):

“Wyden-Bennett has my support because it meets the critical criteria for reform, does it better than HR 3200 and does it without increasing the deficit or requiring net new taxes. Wyden-Bennett has my support because it directly and honestly attacks the central problem of employer based health care insurance as the primary delivery vehicle for non-public health care in America. Wyden-Bennett has my support because it is not (yet) saddled with questionable deals for big pharma, big insurance, and payoffs for big union contributors.”

Saying we support Wyden-Bennett does not mean we have no reservations about this bill. Au contraire mon frère…

Donk Quixote:

“Wyden-Bennett feels like it’s the co-op idea only it takes EVERYBODY’s health coverage away who currently has it through their employer and makes them buy it again. Basically, no more tax breaks for health care. I’m in favor of the principle of that, especially if it could cut costs, but I do think that the radical restructuring of the system would be opposed by many more Americans because it’ll be seen as taking something away from them and would require a lot more work on their part. How do you think a plan that starts off with “First, you lose your insurance…” would play with Americans? Because you know that’s how it would be positioned. This could be a non-starter for many. And to that point, do you really think members of the right wing who kept on saying “Obama is going to raise your taxes!” would stay quiet and accept Wyden-Bennett?

Also, getting back to the co-op idea…does anybody really think creating a system that would dump EVERYBODY off of their insurance is more politically palatable than one that simply opens up options and provides subsidies for those w/o health insurance or those working for small businesses? Bipartisan or not, this bill represents a VERY radical reshaping of how we buy and sell health insurance in this country and such a seismic shift doesn’t seem politically feasible to me.

Phanto:

“I describe myself as a “libertarian-leaning independent”. There are elements of Wyden-Bennett that cannot be reconciled or rationalized with anything that resembles libertarian principles. This is where I have my greatest heartburn with this bill. Chief among them, this bill has mandated coverage. The bill does not work financially without mandated coverage. It works very well with it. It could be rationalized that individuals will have a much wider range of choices under Wyden-Bennett. But I won’t call that a libertarian argument, because individuals will not have the option to not participate.

The trade-off for this mandated coverage is that we get a fiscally sound health care system that covers everyone, that puts no one at risk of financial ruin from getting sick, and does it without raising the deficit or requiring net new taxes. I am willing to take that trade-off. This is why I describe myself as libertarian-leaning as opposed to libertarian or Libertarian. Once in a while, I feel compelled to lean another way.”

Are the politics of Wyden-Bennett within the “art of the possible”?
No idea. It feels like it should be. Universal coverage for all, catastrophic illness protection for all, no increase in the deficit and no net new taxes. What’s not to like?

Clearly there is a constituency on the left who will find nothing less than a Single Payer system to be acceptable. They will never accept this bill and are excluded from the pool of potential supporters. Clearly there is a constituency on the right who will find nothing less than a market based system with little or no government participation to be acceptable. They will never accept this bill and are excluded from the pool of potential supporters. But for the rest, for the wide range of liberals, conservatives and independents who would like to find some common ground and believe there is a need to reform our healthcare system – this presentation is for you:


(There is a four slide “Keep It Simple Stupid” version linked here and embedded at “Divided We Stand United We Fall”.)

Does Wyden-Bennett actually have bipartisan support?
Commenter Mike (not mw) kicked off an interesting discussion among the Donklephant commentariat, questioning whether there is sincere bipartisan support for this bill, or whether Republicans were simply using it for political cover. There is one way to find out. Get behind it, and if there is enough popular support, we will see what happens. Our guess, the compelling fiscal calculus – true reform with no net new taxes and no increase in the deficit – permits the inner fiscal conservative of many Republicans (and Blue Dog Dems) to overcome their other concerns.

Outside the halls of Congress, bipartisan support in the new and traditional media is visible, broad and deep:

  • “[Wyden-Bennett] is probably a better approach than the consensus Democratic plan, which doesn’t have hard cost controls at all, and so doesn’t really explain how it’ll save enough money to be sustainable over the long haul.”
    Ezra Klein
  • “Now you might think that in these circumstances someone might take a second look at the ideas incorporated in the Wyden-Bennett plan, which already has a good C.B.O. score, bipartisan support and a recipe for fundamental reform”
    David Brooks
  • “The Senate’s smartest health-care wonk, Ron Wyden of Oregon, believes we should move away from job-based insurance. He has introduced a bill that would do this by converting the tax deduction for employer-provided health insurance into a tax credit and requiring individuals to use it to buy insurance. This would achieve universal coverage, apply meaningful cost controls, and—according to the Congressional Budget Office—pay for itself within a few years.”
    Jacob Weisberg
  • “The Wyden-Bennett bill is less expensive, covers just as many people and has actual bipartisan support. So far nine Democrats and five Republicans are sponsors, while no Republicans have backed the president’s plan yet.
    Salt Lake Tribune
  • “Despite being the darling of health policy bloggers and the first bill to be certified by the Congressional Budget Office as covering nearly everyone and fully paying for itself, the measure is being roundly ignored by those actually trying to put together a health overhaul measure on Capitol Hill and in the White House.”
    NPR
  • “A divorce of health care benefits from employment would increase social mobility, provide more individual investment in our health, and the reforms present in the Wyden-Bennett proposal would also ensure that people, regardless of pre-existing conditions or age, could still attain health benefits.”
    E.D. Kain
  • “Under the Wyden-Bennett system, health dollars would be controlled by the individual (a long-time conservative goal) and used within a restructured, heavily regulated, totally universal, insurance marketplace (a longtime liberal goal). Each state would create Health Help Agencies, who would provide easy access to insurance products, along with information, guidance, and advice on how to choose. Insurers would have to meet a minimum standard for comprehensiveness (equivalent to the standard Blue Cross/Blue Shield plan currently offered to members of Congress), and they could not discriminate based on pre-existing conditions, occupation, genetic information, gender or age. Nor could they deny insurance to those who ask for it. In return, every American would have to buy health insurance, and there would be hefty subsidies for those further down the income ladder.”
    American Prospect
  • “The idea has a lot of appeal. It would give most people far greater choice than they have now, and they could take their benefits with them when they change jobs. It also provides generous subsidies for those who cannot afford to purchase health care on their own, and yet the Congressional Budget Office has said the proposal would be “revenue neutral,” which means it wouldn’t add to the deficit. It would include a minimum defined-benefits package, with no exclusions for pre-existing conditions.”
    TIME

UPDATE: Simon complains in the comments that the right is underrepresented in this sampling. We strive to please and are adding two more quotes:

  • “The plans favored by Massachusetts Sen. Ted Kennedy or President Barack Obama rely on a “public option” in which government insurance would supposedly “compete” with private insurers, a move many see as leading to a single-payer system. By contrast, the Wyden-Bennett Healthy Americans Act relies on the private insurance market while imposing a series of regulations to squeeze savings from the private sector… The idea, Mr. Wyden says, is to harness the Democratic desire to get everyone covered to the Republican interest in markets and consumer choice. “Everything I’ve been up to with this coalition is designed to make reconciliation irrelevant,” he explains, referring to a political maneuver whereby Democrats might try to force through health reform on a bare majority of 51 votes rather than the filibuster-proof 60 votes normally required. ‘People can’t be tricked into fixing health care.”
    – WSJ
  • “Republicans should embrace universal healthcare by supporting the Wyden-Bennett Healthy Americans Act. There is no another viable way to get rid of the tax-free treatment of employer-provided healthcare benefits that is severely distorting the healthcare market. Once you throw in on top of that greater benefits than those currently offered for families and individuals, consumer choice among competing healthcare plans, portability of health insurance, and (adding in the inevitable under-estimate of total cost) a price tag that costs a trillion dollars less in the next decade than any Democratic plan, you end up with the best bill in either chamber.”
    – Tom Church

It should also be pointed out that, unsurprisingly, there is bi-partisan opposition to this bill. :END UPDATE

In the end, tilting at windmills can be an exercise in futility, but oddly, we still feel pretty good about it.

With that, Donk Quixote and Phanto ride into the sunset.

Cue “Man of La Mancha”

This is my quest, to follow that star …
No matter how hopeless, no matter how far …
To fight for the right, without question or pause …
To be willing to march into Hell, for a Heavenly cause …

And I know if I’ll only be true, to this glorious quest,
That my heart will lie peaceful and calm,
when I’m laid to my rest …
And the world will be better for this:
That one man, scorned and covered with scars,
Still strove, with his last ounce of courage,
To reach … the unreachable star …