I’m deeply skeptical Democrats and Republicans can agree on meaningful, additional, bipartisan health reform. Don Taylor shares my skepticism but still offers his best ideas for compromise. In a related commentary he puts his finger on the fault line. There is fundamental disagreement on mechanism of achieving the coverage and cost goals. Do costs justify coverage expansion or does coverage expansion follow from cost control? Taylor explains,
To simplify, Democrats (liberals/progressives) understand the lack of universal coverage to be an existential mark against our country, really a matter of national shame, and so universal coverage of some sort is their ultimate health policy interest. I am not sure that Republicans (conservatives/liberterians) have one health policy goal that is as widely held as strongly as is universal coverage for Democrats, but I think that worries that costs are too high and the moral hazard of overly generous insurance is as close as you can come. If you combine medical malpractice as a generalized proxy for lawyers/regulation holding back business, then you probably have a comparable Republican interest.
Democrats have just passed a bill that will move us to around 94-95% insurance coverage by 2020; no universal coverage, but creeping up on it. The only way the Democrats will play ball on a compromise is one that produces universal coverage.
If Republicans decided to focus on costs and trade universal catastrophic coverage for heightened cost control, they would deserve a great deal of credit. And they could claim a victory in getting rid of the individual mandate, though of course guaranteed catastrophic coverage is a type of mandate (as is Medicare). They could of course, still claim victory. And Republicans could likely get quite a lot on malpractice reform for universal coverage, which would save some money, but not as much as most think. And the trade of universal coverage for pared back guaranteed insurance levels (high deductibles) would also help to slow cost inflation.
I hope this looks familiar because it means you’re reading Don Taylor. If not, you’re missing one of the best blogs in health policy, politics, and economics out there.
