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In The Public Interest: Finding the High Ground on Health Care

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Yesterday, the United States Senate got a small glimpse of what constructive bipartisan cooperation could look like. And surprisingly, it happened in health-care policy.

Senator Ron Wyden (D-OR), a longtime reform champion, and Senator Scott Brown (R-MA), who campaigned for office last January around a promise to vote against reform, decided that the high ground on health care lay not in re-fighting the last year's battles, but in working together.

These Senators introduced legislation yesterday that would enable states that pass their own health-care-reform package to receive waivers from some health-reform provisions as early as 2014. A similar proposal had been included in the original law, but forced states to wait until 2017 to receive the waivers.

To be eligible, state-reform packages cannot add to the deficit and must match or exceed the coverage and affordability achievements in the Affordable Care Act (ACA). States like Oregon or Massachusetts could continue to press the envelope of what's possible in health reform. And while lightweight, low-impact reform proposals would not likely pass muster, states would be free to develop more comprehensive market-driven approaches, provided they matched or bettered the ACA's achievements.

If Senators Wyden and Brown had chosen to remain isolated in their respective partisan bunkers, they would have had a lot of company among their peers in Congress.

However, a close look at opinion research shows that these two Senators' decision to choose a cooperative approach to improving health policy could have a real constituency among the American people. While most Americans do not believe the law is perfect, most do not support total repeal either.

A CBS/New York Times poll found that among just under half of voters who support repeal, a third change their minds if repeal means that insurers will be allowed to deny coverage due to preexisting conditions. Meanwhile, among the voters who oppose repeal, nearly two-thirds still want to see improvements rather than sticking with the law that passed Congress, according to Election Day polling. The public wants members of both parties to fix the problems that still plague our health-care system, not just argue about them.

Of course, neither the existence of this political high ground, nor Wyden and Brown's decision to occupy it, changes certain basic realities in Washington. The new House majority is almost certain to pass repeal and replace legislation, and those bills will just as certainly fail in the Senate. But what follows this initial political maneuvering could prove critical to our nation's health-care system.

Elected leaders, whether in Washington or state capitols, could spend the next two years refighting last year's partisan debate. Worse, that debate could culminate in the dismantling of important cost-containment policies, such as the provisions eliminating wasteful Medicare subsidies for private insurers, or the stonewalling of implementation at the state level.
What the public wants, instead, is a more pragmatic, cooperative approach, like the one exemplified by Senators Wyden and Brown today. And for those leaders willing to work together, additional opportunities exist for constructive action to reduce health-care costs and improve consumer choices.

First, Congress could take up bipartisan health care transparency initiatives that fell through the cracks of last year's debate. This legislation would ensure that patients and consumers know what their medical care would actually cost before they get the bill in the mail.

Elected leaders could then tackle the incredibly high price of prescription drugs by allowing re-importation of drugs from Canada or increasing the use of cheaper generics in Medicare and Medicaid plans. Inflated drug prices are burdening consumers and they inflate our nation's long-term deficits.

Finally, following the examples of states as diverse as Utah and Massachusetts, state officials could work cooperatively to design private-insurance exchanges. Well-constructed exchanges have enormous potential to increase competition and choice for small businesses and consumers.

Each of these pragmatic, non-ideological solutions can actually help bring down Americans' health-care costs. All enjoyed bipartisan support in the past. And unlike many other proposed health care solutions, taking them up would not impinge on either party's core principles.

Ultimately, for those public servants with enough vision to follow the example Senators Wyden and Brown set today, the high ground is still out there.

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