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The way forward

The televised healthcare reform summit that President Obama convened Thursday didn’t produce any Kumbaya moments or ground-breaking compromises. We hope it will persuade wavering Democrats to push a comprehensive healthcare bill through Congress on their own, because Republicans seem unlikely to change their minds about the measure. Instead, they are intent on starting over with more modest goals.

The summit displayed the broad bipartisan support for core elements of the comprehensive package, but also the fundamental flaws of the narrower GOP alternatives. The best illustration of the difference between the two parties was in their approaches to covering people who can’t get insurance because of preexisting medical conditions. Republicans argued in favor of state-run, federally subsidized insurance pools to serve all the people insurers don’t want to cover. But such an approach would encourage insurers to continue cherry-picking customers rather than pooling risks broadly across the population. Corralling the sickliest people in one group all but guarantees that the cost of insuring them will rise even faster than it has been. By requiring insurers to cover everyone and mandating that everyone obtain insurance, the Democrats’ proposal would spread costs widely without encouraging people to sign up for insurance only after they get sick.

Another illustration came in the debate over minimum federal standards for insurance coverage. Republicans advocated letting individuals and associations of small businesses buy insurance across state lines, avoiding the mandates their state may impose for coverage they don’t need. The Democrats’ proposal would allow sales across state lines, but would require that plans meet a minimum standard of coverage. That’s reasonable, considering how often people are surprised to find out about critical gaps in their coverage when they submit claims. It also would prevent states from engaging in a race to the regulatory bottom in their zeal to persuade insurers to move into their jurisdictions. But Sen. Michael B. Enzi (R-Wyo.) identified a potential middle ground: let insurers offer plans that don’t meet the federal minimum as long as the shortcomings are clearly disclosed.

The session identified a number of areas where the Democrats’ proposal could be improved, such as removing special deals for states and providing more flexibility in the choice of plan. But rather than making a persuasive case for starting over, Republicans showed that their half-steps wouldn’t get to the root of the problems they’re trying to solve. That alone should persuade Democrats to move forward -- through reconciliation, if necessary.


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