By Lanny Davis - 01/27/10 11:35 PM EST
The odds may be slight, but I believe there is still a chance for President Barack Obama to pass a bipartisan healthcare reform bill, even if it represents a small, incremental step that will improve access to healthcare and opportunities to reduce costs.
Of course, there is some evidence that congressional Republicans are not interested in passing any bill at all. But I believe a new approach by the president might work. Start first with a group of thoughtful Republican conservative and moderate senators — those who have demonstrated the willingness and ability to work with Democrats on important issues. I would suggest, for starters, Sens. John McCain (Ariz.), Lindsey Graham (S.C.), Utah’s Orrin Hatch and Bob Bennett, Tennessee’s Bob Corker and Lamar Alexander and the two Maine senators, Olympia Snowe and Susan Collins.
Based on what they have previously stated and stood for, I believe these and other Republican senators would support healthcare reform legislation based on four principles: (1) increased competition; (2) increased transparency; (3) serious efforts to reduce healthcare costs; and (4) increased access of lower- and middle-income people to quality healthcare — funded by actual, realized budget reductions and cash savings to ensure no increase in the deficit.
Here are some ideas that would apply to each of these four principles:
1. Increased competition:
• Pre-empt state laws and allow all to purchase insurance across state lines, not just insurance companies regulated within the state of residence;
• Create national public insurance exchanges accessible to all on the Internet, requiring all companies to compete against each other on the exchange for a national customer base.
2. Increased transparency:
• Require all companies on the national exchange to itemize all policy coverage options on standardized forms, permitting apples-to-apples comparisons (and also giving insurance carriers the advantage of a level playing field on which to compete);
• Similarly, require all physicians, hospitals and providers to disclose all fees and costs on the standardized disclosure forms, including providing patients the most current national and local data available to allow them to compare costs of procedures, tests, services, etc.
3. Reduction of costs:
• Offer tax incentives to physicians who provide flat fees for all services, such as monthly fees for particular patients, rather than fees for particular services, which too often leads to over-testing and -billing;
• Establish a Bipartisan Medicare Commission, similar to the Defense Base Closure and Realignment Commission (BRAC): i.e., a bipartisan body, including key stakeholders such as representatives from the AARP, business, labor, insurance carriers, physicians, and hospitals, which would make recommendations every several years to reduce Medicare spending and waste, and, like the BRAC, all its recommendations for reductions could only be voted down by Congress in their entirety within a fixed time period, or the cuts would become effective automatically;
• Begin the process of tort reform by at least giving physicians or patients involved in a malpractice case the option to choose expedited arbitration by panels composed of medical experts; and establish a bipartisan blue-ribbon commission to propose reasonable limits on damages except in the case of proven recklessness and gross negligence.
4. Increased access to healthcare — with costs fully funded from actual savings and cuts:
• Extend Medicaid to more lower-income people and fund subsidies to middle-income people to allow them to purchase private insurance on the national exchange — but only if these extensions of access can be paid for by realized cash savings from budget cuts and from Medicare and other;
• Give individuals the same tax deductions for insurance premiums as employees covered by employer-provided insurance currently have — again, only if paid for by budget cuts and realized cash savings.
Does this approach satisfy a liberal such as myself who supported comprehensive Democratic proposals guaranteeing virtually universal coverage?
But to me, it does achieve some important reforms in the system that increase opportunities for increasing access and reducing costs.
And most important, it shows the country that it is possible for Democrats and Republicans to work together to make progress on healthcare reform — something all the polls show the large majorities favor — consistent with the president’s campaign theme.
It may not be possible; it probably isn’t. But isn’t it worth a try?
Davis, a Washington lawyer and former special counsel to President Clinton from 1996-98, served as a member of President George W. Bush’s Privacy and Civil Liberties Oversight Board in 2005-06. He is the author of Scandal: How ‘Gotcha’ Politics is Destroying America.