July 26, 2014 SIGN IN | REGISTER

Health Care Debate Remains Mired in Politics

That might be inaccurate in two ways. The premium support for seniors in the Ryan-Wyden plan is less generous than the premium support in the 2010 law, meaning seniors will pay considerably more out of pocket over time. Second, the Ryan-Wyden plan, unlike the overhaul, has a public option!

Nonetheless, most Democrats hate Ryan-Wyden because to praise it in any fashion would mean taking away the sting of their own attacks on Ryan and Republicans for moving “to end Medicare as we know it” — or sometimes neatly forgetting the conditional “as we know it” part.

All of these factors together leave me and others dismayed at the way the driving need to reform health insurance and health care delivery has been caught up in tribal politics, where the identity of the individual promoting or proposing a policy idea is more important than the idea itself.

If I were in the Democratic leadership, I would be tempted to propose a grand compromise: Take the Ryan-Wyden plan and apply it to everyone — insurance exchanges with Medicare as an option for all. That won’t happen, of course.

The Supreme Court may blow up all or part of the 2010 law, throwing its implementation into turmoil. Whether that happens (and there is a good chance the court will punt, putting off a decision until after the elections), if Republicans win the White House and Congress, they will move via reconciliation to repeal as much of the plan as they can. And they will discover that the “repeal” part of “repeal and replace” is a lot easier than the “replace” part.

Perhaps at that point we can do what Rep. Jim Cooper (D-Tenn.), one of the most knowledgeable and clear-headed lawmakers when it comes to health care policy, has urged — that we all check our ideology and blinders at the door to discuss how to improve the health care system.

Perhaps we can open up the debate to rational discussion on what to do about defensive medicine, about how to improve not just insurance availability but the deliverability of health care services to all, about how to deal with the vexing issues surrounding end-of-life care and drivers of health care costs such as diabetes. Perhaps we can discuss the fact that using things such as health savings accounts and requiring individuals to pay for health care services and become better consumers using market forces, while highly desirable, will not take care of the reality that most Medicare spending, and much of the spending for the rest of us, is driven by a small portion of very sick people.

Wouldn’t that dialogue be refreshing? And wouldn’t it be nice if the odds of it happening were better than infinitesimal.

Norman Ornstein is a resident scholar at the American Enterprise Institute.

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