03/18/2010 05:12 am ET Updated May 25, 2011

How to Pay for Health Care Reform: Let the American People (Acting Like a Commission) Decide

I can't talk to you now; there go my followers. (Ascribed to a 19th century European leader, perhaps apocryphal).

The Democrats should pass health care reform, and include within it a "Commission of the American People" to decide how to pay for it.

Just as there have been Commissions on military-base closings and social security reform -- that, Constitutionally, are just advisory, but Congress has agreed in advance to a simple up-or-down vote on their recommendations -- a "Commission of the American People" can render specific recommendations based upon choices enunciated at the ballot box. Congress will ignore that message at its peril.

Since the costs of reform do not kick in until 2013, awaiting a November 2010 verdict on how to pay for it will cause no delays in implementation.

Here is how it would work: as part of the health care reform bill, the Congress (actually, the Democrats in Congress) mandates that every ballot for every federal election in 2010 include the following question of the voter:

The Health Care Reform law reduces the deficit by $123 billion over the first 10 years and even more in the next 10 years. To achieve those savings, additional revenue must be raised. Mark the alternative you prefer:

A. An additional tax on incomes over $500,000 annually;


B. A tax on health insurance plans for individuals that cost more than $X.

According to the Constitution, the legislative authority is vested in Congress. Thus, the outcome of this vote cannot, itself, enact the law. But, Congress can -- as it did with Social Security reform, and the military base closing -- take the outcome of this vote as a recommendation for an up-or-down vote.

This proposal would accomplish several goals. First, it would move the health care reform bill forward to passage by removing one of the more contentious items that needs resolution. Second, it would draw a large number of voters to the polls in the mid-term elections to cast their ballots on an issue that matters deeply to them. Third, it would provide concrete evidence that the Congress truly will listen to the American people as they express themselves as the polls. Fourth, whatever the outcome, it would be invested with a high degree of legitimacy -- no spin, no interminable TV tedium, no craftily worded "polls", just the vote.

To reduce the opportunity for Republican chicanery, the law should state clearly that the issue must appear at the top of the ballot, and impose strict criminal penalties on State officials for hiding or making it anything but clear and unambiguous where the voter makes his preference known on the ballot.

Although as an initial experiment Congress would be well-advised to keep it very simple and limited to a single issue, this mechanism could also be used to address another contentious matter, something like a public option or medicare-for-all. This is how that question might be posed:

Should Congress provide all adult citizens and legal immigrants the opportunity, but not the obligation, to pay their insurance premiums into Medicare, and receive their health care coverage from the Medicare system? The funding basis for Medicare for those aged 65 and over, a 2% tax on payrolls, would remain unchanged.

A. Yes, I think Medicare should be open for those under 65 to pay their premiums into;


B. No, I think Medicare availability should remain unchanged.

I do not know about you, but I am tired of listening to both sides in this and other debates proclaim that the American people are behind them. This mechanism calls everyone's bluff.

The rightwing has said that we are a "center-right" country so long and so unchallenged, that it is taken by nearly all our TV-yapping heads as a truism.

OK, let us call that bluff. I am willing. While I believe the American people have a strong streak of rugged individualism, I have also observed that, just like the big banks who ran to the Government for money when they were in trouble they themselves caused, the American people also want a strong social safety net, a foundation from which that rugged individualism can be expressed. Moreover -- although the topic of another article -- those two strains are not incompatible.

The standard argument, that people choose what they want by determining who is going to represent them in Congress, really holds little water. Issues are not so clear, and people may vote against a candidate who espouses a policy they like because of rumors of a love-child when he (or she) was 17.

Let us see what the American people really want by putting the question directly to them.

Game on?