Tuesday, January 26, 2010

Plan B—There Isn’t One—But There Could Be

As the State of the Union approaches Democrats are considering their health care policy options. There are lots of reports about “Plan B”—pushing through the Senate bill with a parallel corrections bill that could be passed in the Senate using reconciliation rules.

That’s as dead as the original House and Senate health care bills. Moderate Democrats have no stomach for such a legislative stunt in the face of Massachusetts and bad health care polls. Many liberals even question that strategy.

Everyone is awaiting this week’s State of the Union speech. Will the President:
  1. Embrace the call by many on the left to Democrat-up and just ram it through?
  2. Call for a scaled back bill built around modest and popular first steps that could attract bipartisan support?
  3. Just jabber in a way no one can figure out which course he really supports?
My bet is on number three.

As I have said before, I think getting even a modest bill is a long shot in this election year but it is not impossible.

I like the idea of focusing on tax credits for small business as a first priority more than trying to help the individual market. The small group market is guarantee issue and government tax credits have the impact of encouraging matching funds—government money would encourage employer contributions making coverage even more affordable for the uninsured.

Add to that a modest Medicaid expansion, the albeit tepid cost containment parts of the current bills such as the pilot programs and giving CMS more authority to implement them, modest insurance reforms like ending rescission and funding for high risk pools, proving good faith with Republicans by including tort reform, and we have a bipartisan down payment on health reform.

Democrats need to erase the bad taste voters so far have for their dead health care efforts. They could do that with this kind of modest first step health care bill. Republicans also have something to prove on health care—the Democratic problems shouldn’t be confused with any sense on the part of voters that Republicans have yet to make any constructive contribution to this debate.

In my mind, the smart political move for Democrats is to call the Republicans out on their offers to be bipartisan by putting a deal on the table Republicans couldn’t refuse.

If the Republicans take the offer, the Democrats can get beyond the health care political mess they are in. If the Republicans don’t, the Dems have the leverage they need to turn the tables on the Republicans before the November elections.

They could also, coincidentally, actually help out a few million people.

Lots of folks think there is no chance anything positive can now come out of this poisoned political environment.

I am not so cynical.
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