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Alexander: For Health Care Summit to Succeed, Go Step-by-Step

At Thursday’s health care summit, the size of the table is not the first issue. The issue is where to start.

Republicans want to start over. Democrats want to work from their 2,700-page bill passed on Christmas Eve, only to be stymied by the election of the 41st Republican Senator, Scott Brown (Mass.).

Republicans argue that there is no way to pare down the 2,700-page bill. For example, if you take out the Medicare cuts and the Medicaid mandates on state taxpayers — remember the “Cornhusker Kickback” and the “Louisiana Purchase,” sweetheart deals to relieve the bill’s added Medicaid burden in just those two states — and include the $250 billion “doc fix” for physicians who serve Medicare patients, the bill is hopelessly unfunded.

The failed health care bill is only the latest example that the Senate doesn’t do comprehensive well. Despite valiant bipartisan efforts, the comprehensive immigration bill of 2007 also fell of its own weight, as did the comprehensive cap-and-trade climate change bill last year.

That is why on health care and clean energy, Republicans have offered an alternative to thousand-page, surprise-filled bills: going step-by-step in the right direction to re-earn the trust of the American people.

According to the Congressional Record, Republican Senators mentioned this step-by-step approach on the Senate floor 173 times during 2009. On health care, we suggested first setting a clear goal: to reduce cost. Then we proposed the first six steps toward achieving that goal: (1) allow small businesses to pool their resources to purchase health care plans; (2) reduce junk lawsuits against doctors; (3) allow the purchase of insurance across state lines; (4) expand health savings accounts; (5) promote wellness and prevention; and (6) take steps to reduce waste, fraud and abuse. We offered these six proposals in complete legislative text totaling 182 pages. The Democratic majority rejected all six and ridiculed the approach — in part because it wasn’t “comprehensive.”

And in July, all 40 Republican Senators announced agreement upon four steps to produce low-cost clean energy and create jobs: (1) build 100 nuclear power plants; (2) electrify half our cars and trucks; (3) explore offshore for natural gas and oil; and (4) double energy research and development.

Here’s a bipartisan example of how working step-by-step can succeed. In 2005, I joined with other Members of Congress in asking the National Academies to identify the first 10 steps Congress should take to preserve America’s competitive advantage so we can keep adding jobs. The academies appointed a distinguished panel that recommended 20 such steps. Congress enacted two-thirds of them. The America COMPETES Act of 2007 was far-reaching legislation, but it was fashioned step-by-step.

If the United States were small like Denmark, Congress could enact comprehensive solutions all day long. But it is arrogant to imagine that 100 U.S. Senators are wise enough to reform comprehensively a health care system that constitutes 17 percent of the world’s largest economy and affects 300 million Americans of disparate backgrounds and circumstances. Political scientist James Q. Wilson says that the law of unintended consequences causes the failure of such huge schemes. “This is not an argument for doing nothing,” he recently wrote, “but ... for doing things experimentally. Try your ideas out in one place and see what happens before you inflict it on the whole country.”

The path to a successful health care summit is to put the 2,700-page comprehensive bill on the shelf, set a clear goal of reducing costs and take a few steps in that direction. Then perhaps we can agree on a few more and start solving our country’s problems in a way that re-earns the trust of the American people.

Sen. Lamar Alexander (Tenn.) is Senate Republican Conference chairman.

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