The precondition for ‘bipartisan’ reform

THE PRECONDITION FOR ‘BIPARTISAN’ REFORM…. Sen. Chuck Grassley (R-Iowa), ranking member on the Senate Finance Committee and arguably the lead Republican negotiator on health care, argued on MSNBC this morning that a public option was a deal-breaker for the minority party. Period.

If the legislative package is going to be “bipartisan,” Grassley said, “We need to make sure that there’s no public option.”

This comes up from time to time, but hearing Grassley take an unyielding position on the proposal embraced by most Americans, the president, and most of Congress reminded me that it’s worth reiterating why there are fundamental flaws in trying to prioritize Grassley’s happiness. A.L. had a great item on this last night.

Health care policy is a definitional issue in American politics. For as long as I can remember, the Democratic party has fought to increase the government’s role in providing health care coverage for Americans while the Republican party has fought to reduce the government’s role. The Democrats are responsible for Medicare, Medicaid, and S-CHIP; the Republicans fought all of those initiatives. On a policy level, the Democrats believe that the best health and cost outcomes can be achieved by increasing access and encouraging widespread use of routine and preventative medical care. Republicans, on the other hand, have routinely identified the problem as over-consumption of care. Their proposals to fix the system inevitably involve significant deregulation with the goal of encouraging the use of high-deductible policies to try to discourage personal consumption of health care. Nearly every Democrat (including the blue dogs and “centrists”) believes this to be bad policy.

In other words, there is virtually no common ground between the parties. The parties don’t even see eye-to-eye regarding basic goals and policy assumptions. So why on earth would anyone believe that there is a bipartisan solution to health care? If one side believes the answer is behind door #1 and the other believes it is behind door #2, the correct answer is never to walk into the wall between the doors. Yet any conceivable “bipartisan solution” to health care would amount to exactly that.

This is especially true when dealing with a small (and shrinking) Republican minority, which has done nothing but act as an obstructionist force, and which has a vested interest in ensuring that reform efforts fail.

On a related note, Sen. Max Baucus finally realizes that it was a mistake ruling out the very possibility of a single-payer system, before the debate even began, if no other reason because it threw off the balance of negotiations.

Imagine where we’d be right now if, on the one hand, Dems were pushing a single-payer plan, and on the other, Republicans were pushing a protect-the-insurance-industry-at-all-costs proposal. At that point, the “bipartisan compromise” could have settled around a system in which private insurers competed with a public option — which just so happens to be the mainstream Democratic position right now.

Sooner or later, Democratic policymakers — on both ends of Pennsylvania Avenue — are going to realize that they keep entering these talks with the fulcrum in the wrong place.