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D. Brad Wright

D. Brad Wright

Posted: August 19, 2009 09:35 PM

Piecemeal Health Reform: Could It Work?


Incrementalism usually seems a little bit easier for everyone in this country -- politicians and the public -- to swallow. It's not surprising then, that one of the major objections raised in the health reform debate is the enormity of the House bill. For those of you who haven't had the pleasure of reading it in its entirety, it's lengthy. 1,018 pages long to be exact. Hence the claims that legislators haven't read the bill and don't even know what's written in it. (For the record, I don't think that's true, but it does make for a fantastic sound bite.)

So, what if the Democrats pursued health reform incrementally? Now, I'm not suggesting starting small in hopes of expanding the reform through subsequent legislation. That was the intent with Medicare, and we see how well that's managed to work. No, rather what I'm suggesting is simply dividing the current health reform bill into several smaller -- and, therefore, more easily digestible -- pieces.

What I'm proposing is something like this: Write one bill that creates a health care exchange for private insurers and allows the uninsured to effectively buy into a large national pool (as opposed to the prohibitively expensive non-group market). Write another bill that amends the tax code by making insurance coverage mandatory, enforcing the mandate through tax penalties, and offering tax-financed subsidies to help low-income persons purchase coverage. This bill could also create the much-maligned "public option" to provide another viable option for individuals who must purchase insurance. Finally, a third bill could expand Medicaid eligibility limits upward, implement Medicare payment reforms to eliminate waste, and perhaps consider eliminating some portion of the tax-preferred status of employer-based health benefits.

Why do things this way? I'll admit that it almost seems to make things more complicated, but it's really a matter of political feasibility. You see, the first bill doesn't do much other than present some new regulations on private insurers. The need for such regulations is acknowledged from members of Congress on both sides of the aisle. That's not to say there wouldn't still be strong Republican opposition, but it's easy to imagine enough moderates supporting the effort that the 60 votes needed for cloture would be reached.

Things would probably get a little bit more heated on the second two bills, but there is enough Democratic support to ensure that these two bills could be passed through as part of reconciliation. Of course, reconciliation bills expire after 5 years without reauthorization, but if the current health reform debate has shown us anything, it's that the status quo is always hard to change. If Democrats can get one win under their belt (on the first piece of legislation), and then pass the other two measures through later, Obama's "wish list" will come true, and it would take an awful lot of effort to undo. I'm not saying it's the only option, or even the best one, but it's worth thinking about.

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