May 14, 2007
Washington remains deadlocked over healthcare reform, but a solution to this long-term problem may be close. The lack of federal action has spurred many states to act on their own to reform their healthcare systems.
And here, ironically, is where Congress can help. A bipartisan group of federal lawmakers are capitalizing on this trend by supporting and encouraging state innovation. One unlikely pair, Sens. Russ Feingold (D-Wisc.) and Lindsey Graham (R-S.C.) have joined together to introduce the State-Based Health Reform Act.
These members, like most in Congress, disagree on how to extend insurance coverage. Some favor a more government-centered system. Others want a more market-based system. Still others hope for some combination of the two.
What unites ideologically diverse lawmakers such as Feingold and Graham? It's the same thing that led Sens. Jeff Bingaman (D-N.M.) and George Voinovich (R-Ohio), and Reps. Tammy Baldwin (D-Wisc.) and Tom Price (R-Ga.) to introduce similar legislation. And it's what drove us -- two think tank analysts with very different views about health reform -- to develop the approach encapsulated in these bills: an overriding desire to fix the problem.
Rather than perpetuate the fruitless debate that has persisted for decades, we all favor trying a variety of ideas to see which works. And we accept that one idea might work better in South Carolina and another in Wisconsin.
It's a "let a thousand flowers bloom" approach. Under the Feingold-Graham bill, any state could propose a solution to improve coverage within its borders. The proposals could involve radical changes to federal, as well as state, health programs. One state might seek to spend federal money through a single-payer model. Another might look at a universal Health Savings Account model. Yet another might create federal-state tax credits or vouchers to help people buy insurance.
Each plan would have to include clear, measurable goals for improving coverage over a five-year period. And each would have to specify the bottom line costs for the federal government.
A bipartisan taskforce -- made up by the U.S. Secretary of Health and Human Services and a diverse group of stakeholders in the healthcare system, picked by Congress and the comptroller general -- would review the state proposals and select a "slate" spanning the ideological range.
This slate would go to Congress for an up-or-down vote with no amendments -- all or nothing --with rules to prevent stonewalling and political micromanagement. If chosen, a state plan would last for five years. It would get a share of the $40 billion allocated for this experiment, which is paid for through various offsets.
The bill makes political sense because all proponents -- right, left and center -- would have the chance to see their ideas tried out as part of an agreed slate. Liberals and conservatives alike should know that congressional polarization and gridlock today means that their pet ideas will not make it through Congress alone. As part of a taskforce slate, however, both would see their ideas tried and get a fair test.
Sen. Graham doesn't think Sen. Feingold's desire for single-payer healthcare is a good idea. Sen. Feingold thinks Sen. Graham's trust in a consumer and market-based system won't work. But each can support a bill that lets both ideas be tried and compared.
The assurance that competing ideas from both sides get tried is one key ingredient of the bill. Another is the recognition that long-term answers on health coverage will come from the bottom up, not the top down. Rather than continue the fruitless effort to find a single approach that can win national approval, the Feingold-Graham bill would simply set broad goals and then invite the states to devise ways to reach those goals.
Against the prevailing background of poisonous, partisan bickering, there is something very heartening about a group of ideologically diverse members willing to work together, willing to respect each other and allow each other's ideas to be tested, and willing to accept that the best ideas to fix healthcare are likely to come from outside Washington.
Divided government requires bipartisan action to get serious progress on tough issues. If Sens. Feingold and Graham and their colleagues with similar approaches can succeed on health, perhaps bipartisan collaboration can be saved from extinction. Then maybe, just maybe, we can get some things done.
Stuart M. Butler, Ph.D., is Vice President for Domestic and Economic Policy Studies, and Henry Aaron is a Senior Fellow at the Brookings Institution.
First appeared in WashingtonPost.com