Both sides still need a health reform deal

On December 16, 2010 I finished a post entitled, “What would a compromise look like?” in this way:

The Democratic party invested much political capital and time to pass the ACA. The Republicans have talked about many of the ideas above over the years, but it is worth remembering that they passed none of this when they controlled both Houses of Congress and the White House from 2002-2006. No federal bill to expand insurance purchase across state lines; no medical malpractice reform; no changing of the tax treatment of employer paid insurance. Now that they control the House of Representatives, I hope they will work to pass some health reform legislation, and thereby continue the health reform discussion that is needed if we are to ever develop a sustainable health care system.

1,300 days after I wrote the post linked above, Speaker Boehner this week noted that House Republicans were “still working” on that replace bill. The recent reform conservativism policy initiative is welcomed by me, because our country needs an invigorated policy-based debate. However, I found the health policy chapter in the the recent YG Network volume to be lacking in specificity, both as compared to other proposals written by Jim Capretta the author of the chapter, but also as compared to the rest of the topical chapters.* However, this lack of specificity shows that the document wasn’t meant to entice liberals into a deal, but instead is trying to get elected Republicans to inch toward being willing to vote for something on health reform (Ramesh Ponnuru & Yuval Levin pleading with elected Republicans to be for something in health reform). I think that is the distinction that Yuval Levin is making in this piece.

Republicans/Conservatives need a health reform deal because they can get more out of a deal than they could ever get in passing their own plan, precisely because there are very few elected Republicans who are willing to take hard votes on health reform. And in the attempt to reinvigorate reform conservative thought generally, non health policy areas are likely to be easier for them because Republicans have scorched much of the Earth into which they might seek to create a reform plan. And looking ahead to the next Presidential election, a Republican nominee might be lots better off focusing on non health reform issues if a deal could be had.

Democrats/Liberals/Progressives need a deal because of the uneven roll out of the post-SCOTUS ACA in which the poorest states are sitting out Medicaid expansion. I have no idea what the final result of the Halbig/King litigation will be, but even if SCOTUS ruled that tax credits could only flow to people purchasing insurance via an exchange established by a state, setting one up is simple enough, and it should be fairly straightforward for any state to establish an exchange while outsourcing most functions to the federal government. The worry for Dems/Libs/Progs of course is that the poorest Southern states will not make this move, and we will land in a perverse outcome whereby the poorest states essentially sit out the ACA’s coverage expansions, via both Medicaid and private insurance.

So, if Republicans need a deal because it is very difficult to imagine them passing a health reform plan on their own any time soon, Democrats need one because the holy grail of public policy for them (universal health insurance coverage) is particularly thwarted by the uneven roll out of the law, and the law even if perfectly implemented would not get to universal coverage in any event. Another step (and another, and so on; we will never be done seeking to improve value for money spent in health care), was always going to be needed, and indeed is needed.

1,300 days later, both sides still need a health reform deal.

*this may be how everyone sees their area–too simplified, and things they don’t know as well seem newer/fresher/more interesting.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

5 Responses to Both sides still need a health reform deal

  1. Bob Hertz says:

    Thanks for sound comments. However a man from Mars would ask the following question:
    why aren’t the poor states enthusiastically supporting federal programs that would benefit them the most?
    If 25% or more of a state’s population would benefit from Medicaid, that kind of voting bloc could in theory enact almost anything it wanted to.
    I remember when TennCare was abandoned, even though more than 25% of the state’s residents were benefitting.
    The real problem is suspect is that those who benefit are not a voting bloc at all. I could understand that when poll taxes and raw racism kept blacks from voting until the 1960’s. It is harder for me to understand why the far right dominates these states even today. I welcome any explanations!

  2. Pingback: The thing that worries me most about the long term health system outlook | freeforall

  3. Pingback: Avik Roy’s health reform proposal | freeforall

  4. Pingback: Avik Roy’s health reform proposal

  5. Pingback: Both Sides Still Need a Deal | freeforall

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