On Health Care Smaller Might Be Better

Scott Brown's victory in Massachusetts immediately jeopardized President Obama's health care bill and forced the White House to figure out a strategy for what to do about health care reform and the bill itself. At least for the moment, the strategy seems to be to put health care on the back burner while focusing more directly on job creation so that the administration can demonstrate its awareness of, and try to do something about, the ongoing impact of the economic crisis, particularly with regard to unemployment.

For reasons of both politics and substance, the White House is wise to focus directly on the jobs and unemployment at this time. Additionally, pushing through a deeply, and probably permanently, flawed health care bill is not an obvious win for the White House. Nonetheless, by the end of 2009 the White House was presenting health care reform as almost a fait accompli and a major accomplishment for the administration. Walking away from that bill now, while not entirely a bad idea, does not make the administration look good. Moreover, simply passing the senate bill or other legislative pyrotechnics are probably a lot more difficult that then they sound at first.

This leaves the administration with few good options on health care, but there is one possible solution that would allow the administration to claim a victory, accomplish a more modest but also more unequivocally positive goal for the American people, and put the Republican Party in a more difficult position. As part of the effort to get the necessary votes President Obama has embarked on a succession of compromises which has led to the current bill which requires the uninsured to buy health insurance but with no public option or Medicare expansion. These compromises have upset many progressives and have not guaranteed passage of the bill.

Rather than further compromising on how to expand coverage, the administration should instead compromise on scope. By making this bill about reforming health insurance companies, but not about expanding health coverage the administration would end up with a better, more politically viable bill. It would not solve the fundamental problem of so many Americans being without health insurance, but it would also not preclude subsequent solutions as, for the most part, the current bill does.

This would not require writing a new bill, but would only require the congress to drop some of the provisions in the current bill. The best elements of the current bill, and the ones even committed supporters of a more progressive approach support, are aimed at reforming the health insurance companies by not allowing these firms to refuse to insure people based on existing conditions or to drop people from their plans because of arbitrary reasons. Additionally, the bill would raise the age until which young people can remain on a parent's policy.

The result of this solution would be a far more limited, but more unequivocally positive bill, one more accurately described as insurance reform, not health care reform. This limited bill would be of great value to those are currently insured but still subjected to capricious abuse from the insurance industry. Additionally, while it would not in any way address the crisis facing those who are not insured, it would also, unlike the current senate bill, keep the possibility of applying a progressive solution to this problem alive.

Compromising on the scope of the bill, rather than on compromising away basic principles would also force opponents of the bill to change their approach as well. Opponents to progressive health care reform have based their opposition around the bogeyman of government takeover of health care, an expanded role of government and, more generally and outrageously, creeping socialism. Changing the bill to simply be an insurance reform bill would catch opponents off-guard and force them to change base their opposition on less familiar and comfortable ground.

Opponents to this bill would be forced much more explicitly to explain not their opposition to big government, but their warm feeling for the health insurance industry. This is not a moment when appeals to the value of unfettered capitalism and the evils of regulation are likely to get much traction from the American people, but this is the narrative opponents of the scaled down bill would have to create.

This solution is clearly not perfect because it does nothing to expand health coverage to those who do not have it which means it does not solve the biggest health care problem facing the country. However, unlike the current senate bill, it would not lock us in to a system that would preclude more meaningful reform in the future. The scope of the bill would be smaller, but the substance of the bill would be better. The administration has already failed, for now, in achieving the goal of universal health care, but a good health care bill that would immediately be successful and popular and have a concrete impact on the health care of many Americans would leave that door a bit more open.