Instead of starting legislation off from the left, it will need to build a majority from the center out. As Maine Republican Olympia Snowe pointed out this week, the Senate Finance Committee’s “group of six” process broke down because the White House thought that bipartisan cooperation was tedious and too slow to get a bill wrapped up by its original August deadline.
An incremental reform could use targeted individual tax credits to help the uninsured buy coverage immediately—while gradually shifting the tax code away from its current bias for workplace insurance only, without cannibalizing people’s current coverage. States could be encouraged to experiment with Medicaid block grants, or to set up “exchanges” in which insurers would be held accountable but also compete to offer the benefit mix that consumers find most valuable.
The main focus should be on lowering health costs through markets, price signals, innovation and the resulting efficiencies. This kind of policy shouldn’t be controversial in the postwar U.S., except that it has never been tried in health care.