Have Scott Brown and Ron Wyden figured out the way forward on health care?
The GOP’s slogan on health-care reform has, till now, been “repeal and replace.” But they don’t have the votes for either. What they might have the votes for is reform that, maybe, one day, if all goes well, could lead to replacement. And, believe it or not, liberals might be able to get on board with this strategy, too.
This morning, Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) introduced the “Empowering States to Innovate Act.” The legislation would allow states to develop their own health-care reform proposals that would preempt the federal government’s effort. If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would’ve given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill.
Wyden, with the help of Sen. Bernie Sanders (I-Vt.), was able to build a version of this exemption into the original health-care reform bill, but for various reasons, was forced to accept a starting date of 2017 -- three years after the Patient Protection and Affordable Care Act goes into effect. The Wyden/Brown legislation would allow states to propose their alternatives now and start implementing them in 2014, rather than wasting time and money setting up a federal structure that they don’t plan to use.
In general, giving the states a freer hand is an approach associated with conservatives. On Wednesday, Sen. Orrin Hatch (R-Utah) sent a letter to the Republican Governors Association advocating exactly that. “The most effective path to sustainable health care reform runs through the states, not Washington,” he wrote. If it’s really the case that the states can do health reform better, Wyden and Brown are giving them a chance to prove it.
One state that wants to prove it is Sanders’s Vermont. “As a single-payer advocate,” he says, “I believe that at the end of the day, if a state goes forward and passes an effective single-payer program, it will demonstrate that you can provide quality health care to every man, woman and child in a more cost effective way. So I wanted to make sure that states have that option.” Vermont’s governor-elect, Peter Shumlin, is on the same page. “Vermont needs a single-payer system,” he said during the campaign.
Single-payer, of course, is even more objectionable to conservatives than the existing health-care law. But that’s the beauty of this option: It allows the liberal states to go their way, the conservative states to go their way, and then lets the country judge the results. If Vermont’s single-payer system provides universal care at a low, low cost, then maybe that nudges California -- which is facing massive budget deficits -- off the fence. After all, if the state spends less than the government sends it, it gets to keep the remainder. It’s a nice incentive for cost control. And if it works, how long will more conservative states wait before they decide to take part in the savings, too?
But conservatives don’t believe that will happen. They think a consumer-directed system will offer higher-quality health care at a lower price, and with more choice. If Tennessee takes that route and outperforms Vermont, it’ll be their system that spreads across the land.
The funny thing about the health-care reform debate is that for all the arguing, everyone says they’re in favor of it. The GOP’s "Pledge to America," for instance, promises that the Republicans will repeal Obama’s health-care law “and put in place real reform.” Shumlin, too, promises Vermonters that he’ll produce “real reform.” The problem is that no one seems able to agree on what real reform is. The beauty of Wyden and Brown’s approach is that the country doesn’t have to choose.
“Real reform,” in their world, is whatever works best to cover everyone at the lowest cost.
Utah and California can go their separate ways, and the other states can judge the victor based on results, not ideology.
That an Oregonian and a Bay Stater are behind this legislation is perhaps no surprise: Wyden’s home state of Oregon just reelected John Kitzhaber, a former emergency-room doctor who pioneered a radical set of Medicaid reforms when he served as governor in the late '90s and early Aughts. Brown’s constituents in Massachusetts still overwhelmingly support the system that then-Gov. Mitt Romney signed into law in 2005 -- and that then-state Sen. Scott Brown voted for. “There’ve been a handful of states that’ve tried for some time to break out from the cookie-cutter molds,” says Wyden, and their senators want to protect their innovations.
The Obama administration is cautiously supportive. "The cliche about states as the laboratories of democracy is not just a cliche," CMS director Don Berwick told Wyden at a Finance Committee hearing. "It’s true." The question is whether the rest of Congress will agree. Liberal Democrats might shiver at the thought of conservative reform plans, while conservative Democrats might worry about the possibilities of public options and single payer. Republicans may worry that attempts to reform the health-care law will read to their base as if they’re making peace with it rather than working to repeal it. And both sides will face pressure from various industries involved in the provision of medical services that fear -- and will likely fight -- the prospect of reforms they can’t anticipate, and may not benefit from.
But those who hide from this proposal are fundamentally signaling a lack of faith in their own ideas. What Wyden and Brown are offering is the chance for the various sides to prove that they’re right. If the industry players make the system work better, then the states that prize their involvement will prosper. If conservative solutions are more efficient, that will be clear when their beneficiaries save money. If liberal ideas really work better, it’s time we found out. Forget repeal and replace, or even reform and replace. How about compete and succeed?
Originally Posted by Marx & Lennon
