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Roll Call

Congress Should Reform Health Care Kennedy’s Way

Among the most common themes in the tributes paid to the late Sen. Edward Kennedy (D-Mass.) was his willingness to negotiate across party lines and achieve his liberal goals incrementally, if necessary.

It’s time for his fellow Democrats and President Barack Obama to apply those principles to health care reform.

So far, except in the Senate Finance Committee, there’s been almost zero Kennedyism applied to the health care debate.

The House Democratic majority has produced its health legislation with a contempt for the minority that’s customary for that chamber — but inappropriate when huge changes for one-sixth of the U.S. economy are in play.

The Senate committee Kennedy formerly chaired — Health, Education, Labor and Pensions — likewise produced a government-heavy bill with no GOP support.

It is a “Kennedy bill,” representing the “liberal lion’s” fondest hopes for universal coverage, a “public plan” that would eventually lead to Canadian-style medicine, and huge cost.

But the chances are that, had Kennedy lived, he would have used that bill as the basis for negotiation and would have accepted less than his ideal in order to make progress.

For, as David Brooks wrote in the New York Times, “Kennedy never abandoned his ambitious ideals, but his ability to forge compromises and champion gradual, incremental change created the legacy everybody is celebrating today: community health centers, the National Cancer Institute, the Americans With Disabilities Act, the Meals on Wheels program, the renewal of the Voting Rights Act and the No Child Left Behind Act.”

Brooks left out the 1996 Kennedy-Kassebaum Health Insurance Portability and Accountability Act, in which he and former Sen. Nancy Kassebaum (R-Kan.) created COBRA, the program allowing laid-off employees to keep their health insurance, and the 1997 State Children’s Health Insurance Program, passed with Sen. Orrin Hatch (R-Utah) as co-sponsor.

President Obama, who got elected promising to heal the nation’s partisan breaches, has failed to insist that Republicans and their ideas be incorporated into health care reform.

So without buy-in, Republicans have been bent on playing up the flaws in Democratic health care plans. Many of them might be doing it anyway, but Obama hasn’t met them a quarter-way, let alone half.

And the result is that the opposition has sewn severe doubts about the whole reform enterprise — some of it legitimate (such as worry about the “public plan” and cost) and some of it paranoid, such as “death panels” allegedly deciding which seniors will live or die.

Liberals still dream of ramming their kind of bill through the Senate with 51 votes through the budget reconciliation process, but that — if it’s even possible parliamentary — will ensure that Obama matches George W. Bush as a polarizing president.

The better way is for Obama at some stage, the earlier the better, to take some sound outside advice and redirect the health debate toward the center.

Some good principles were laid out in a National Press Club speech in 2008 by Donald B. Snow, CEO of Medco, the pharmacy management company.

“First, he said, we need to keep it simple. Complex solutions always fail. Second, we need to phase in incremental changes. Revolutionary reform is rejected by our society.

“Finally, and most importantly, we must carefully define the roles of the private sector and the government. ... The government’s strength is to promulgate and regulate. The private sector’s strength is to operate and innovate.”

Another piece of good advice came from former Sen. Bill Bradley (D-N.J.) in last Sunday’s New York Times.

He counseled passing health reform the way he, President Ronald Reagan and others enacted tax reform in 1986 — by combining top priorities of both parties.

For health care, that would mean universal coverage for Democrats and significant medical malpractice reform for Republicans.

Republicans also favor, as should many Democrats, enabling uninsured individuals and the self-employed to get the same tax advantages as do people insured by their employers.

Practically everyone — including health insurance companies — agree that the insurance market needs to be reformed to eliminate exclusions based on pre-existing conditions, denial of coverage to the sick and placing caps on coverage.

If those mandates are imposed, premiums will rise for everyone who has insurance — unless there is a mandate that everyone have insurance, including young, healthy people who now think they can go without.

Reports have it that Obama plans to change his emphasis in selling reform this fall to the moral case that 47 million Americans should not go uninsured.

It’s the right strategy, but he should combine it with the self-interest argument that covering everyone will hold down premium increases for those who already have insurance.

It will also hold down costs if a new malpractice system is created — including specialized “medical courts” to replace juries — so that doctors stop practicing “defensive medicine” to avoid getting sued.

And, to achieve bipartisanship, Obama will have to jettison a Medicare-like public plan, but to appease liberals he could resurrect the idea of a “trigger” that would put a public plan into place if insurance companies fail to deliver on required reforms.

Edward Kennedy surely would not have been happy with such concessions, but would he have made them to achieve universal coverage, the top priority of his career? I bet he’d be negotiating with Republicans on it as we speak. And so should Obama.

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