I happen to be a liberal Democrat. And I think I'd probably prefer a single-payer system similar to Canada's -- in which the government guarantees all adequate health care but private medicine is still available.
But I also understand there are grave and legitimate concerns in this country about a socialized medical system. And since we live in a democracy, we Democrats should try to avoid running over people, even though we have a majority in both houses of Congress, just because we can -- not on an issue representing nearly one-fifth of the nation's economy.
So I am shocked at the strident attacks on President Obama in recent weeks from his base, his hard-core supporters on the left, because he and his White House colleagues have suggested that they could ultimately support legislation this year that will take a substantial step toward reforming America's health care system -- but may not include a "public option", i.e., a government-provided insurance program to compete with private insurance policies.
For example, I have heard some members of the House Democratic progressive caucus and liberal cable TV talk-show hosts and guests actually state that they would rather have no health care reform legislation this year at all if there is no "public option." And in recent weeks at least some liberals on TV and the blogosphere are actually already talking about running someone in a Democratic primary against Mr. Obama in 2012. With such friends....
Therefore, at the outset of his speech to Congress, Mr. Obama might want to turn to the Democratic side of the House and ask his fellow Democrats:
"If we can guarantee access to quality health care for almost all Americans, would you really prefer no bill at all because we can't pass a public option this year?"
Then he should ask: "Is there anyone among my Democratic friends who take that position who do not have any insurance? I doubt it."
Then he should turn to the Republican side of the aisle, and ask:
"How many of you believe that there are death panels favored by Democrats? How many of you believe that we want a socialized system when you know what we have proposed preserves everyone's current private insurance policy options? How many of you agree that it's okay to lie and distort and shout other people down who may support health care reform rather than engage in honest and respectful debate?"
Then he should say:
"I respect all of you who disagree with me on this. And I assume you are just as disgusted by these voices of hate and distortion on your side of the aisle as I am -- and that you want to work together with me and your Democratic colleagues to come up with a solution that most of us can support."
And then, it would be time for the pivot to propose a health care plan based on principles that the Great Center of American politics can support -- one that (1) mandates that all employers provide insurance; (2) mandates all insurance companies to provide adequate coverage regardless of pre-existing conditions or other loopholes; (3) institutes cost-cutting and structural reforms to reduce overall health care costs that, if left unchecked, will bankrupt us; and (4) subsidizes premiums for the poor and the lower middle class and as many people as possible within the limits of today's soaring deficits and continued recession.
That may mean that, for this year at least, public subsidies might not cover 100 percent of all uninsured Americans, depending on how well the rest of the program demonstrates reduced health care costs.
"There's always next year," he could say. "Let's see how we do in our first year or so with the new system -- including whether public exchanges and possibly co-ops can provide competitive pressures on insurance companies absent a public option."
One little-noticed proposal has attracted an ideologically breathtaking span of senators and seems to have been unjustly overlooked in the debate: the Healthy Americans Act, sponsored by liberal Democratic Sen. Ron Wyden of Oregon and conservative Republican Sen. Robert F. Bennett of Utah. The amazing list of 15 co-sponsors includes eight Democrats, such as progressives Bill Nelson of Florida, Debbie Stebenow of Michigan, and Maria Cantwell of Washington, and seven Republicans, such as conservatives Bob Corker of Tennessee, Mike Crapo of Idaho and Charles E. Grassley of Iowa.
I had heard about this bill but never took the time to look it up and research it. How is it possible we know so little about it? And why hasn't Mr. Obama invited these 15 senators to the White House to have them explain it better? Maybe he should before his speech Wednesday.
The basic idea of the proposal is, in effect, to "liquefy" everyone's current employer-provided health insurance policies -- i.e., require all employers to pay in cash to each employee the actual cost of that individual's insurance policy, and that extra compensation would have to be used by each employee to purchase health insurance policies. All those receiving this boost in pay would receive a tax deduction, varying in amount according to their income -- i.e., you get some or all of the tax deduction the employer currently gets for paying your insurance.
Those employers who do not insure their employees would have to make an "employer shared-responsibility payment," the amount depending on their revenues and size of their work force, as would all self-employed individuals and all those who do not have insurance and can afford to make this payment.
These new sources of revenue for the federal government, plus higher revenues owing to elimination of various currently applicable tax deductions and credits, would finance the cost of subsidizing the premiums of those who cannot afford to pay for private health insurance -- 100 percent for those at or below poverty level and a sliding scale of subsidies on up into the middle and upper-middle class.
And here's the most remarkable fact:
The Congressional Budget Office and the Joint Tax Committee have determined that the plan would be deficit neutral during its first two years (spending would be offset by these increased tax revenues), after which time, the plan would generate net revenue. Meaning, it would help reduce the deficit, rather than increase it ... amazing!
I understand that there are offsetting concerns to this Wyden-Bennett proposal -- the most serious being it may be risky to put too much faith in the ability of individuals to make the right choices when it comes to the complex world of health insurance options. (Remember Grandma not being able to figure out all those complicated prescription-drug insurance policy options?)
But the bill sets up state "Health Help Agencies" to explain, coordinate, and make all private insurance options available -- plus private-market insurance brokers are still going to be around to offer advice and assist in making the right choice for each individual or family.
In short: With such a broad, bipartisan group of senators to work with, the Wyden-Bennett plan may be a better place to start than what we have seen to date.
So, good luck Wednesday night, Mr. President. If this were a basketball game, you would fake left, then right, and then drive hard into the bipartisan center lane to sink the winning basket -- the lane where most voters are and where the country sorely needs you to be.
Lanny J. Davis, a Washington lawyer and former special counsel to President Clinton, served as a member of President George W. Bush's Privacy and Civil Liberties Oversight Board. He is the author of Scandal: How 'Gotcha' Politics is Destroying America. This piece is also published at http://pundits.thehill.com and appeared on Monday, September 7, 2009 in Mr. Davis's regular Monday column in the Washington Times called, "Purple Nation."