How Would a Bipartisan Health Bill Be Possible?

One possibility: Maybe the small dog is the right dog for this environment. (Image: Thinkstock)

Is that my ideal health care system? No. But it gives Republicans some of what they want (a more consumer-driven, pro-market program in the individual market, and a big start toward reforming the bloated and byzantine mess that is the Medicaid program). It gives Democrats some of what they want (money for people who don’t have very much of it, plus they don’t get splattered by the fallout of Obamacare exchanges melting down). In theory, it could pass.

And in theory, I could play third base for the Yankees, if Joe Girardi were willing to hire me. The truth is that after years of complaining about obstructionism, Democrats have developed a sudden taste for the stuff; there’s a substantial faction of both politicians and voters who want the Democrats to stand by and do nothing, nothing, that Republicans might like. And even among those who think they want bipartisan compromise — well, I spend a lot of time listening to those folks, and when you get down to it, frequently their idea of a “compromise” is that they get a huge government program that costs hundreds of billions of dollars, and Republicans get trivial increases in the size of health-savings accounts, and maybe to twiddle with a few of the outer decimal points on growth rates. In other words, what they think is a vision of compromise is too often actually a vision of America ca. 1992, when Republicans were a minority party who had to come begging for crumbs.

Republicans, meanwhile, don’t even have that much of a coherent vision. Too many of them have an ardent desire for Obamacare not to ever have passed, and no idea how to either get the country back to that point, or live with the new reality. The continued existence of Obamacare in largely its current form is a dealbreaker for both parties, which means there’s unlikely to be a deal.

That said, Congress has been able to pass a couple of bipartisan health care bills in recent years: the 21st Century Cures Act in late 2016, and the Medicare Access and CHIP Reauthorization Act of 2015, more commonly known as the “doc fix” bill. The former reforms mental health care and funds medical research; the latter, most important among its provisions, permanently jettisoned an enormous scheduled cut in Medicare doctor reimbursements, which Congress had been frantically putting off for years and finally recognized was never going to happen. Both bills passed by overwhelming margins.

What do we see in these bills? The sums involved, while hardly trivial, are small relative to the federal budget. The scope of the bills was modest, and each of them had well-organized and mediagenic interest groups lined up in support. The changes made were technical matters that were not explained to large numbers of people, because neither bill was well known to many voters. And while the absolute number of people directly affected by them was large, the percentage of voters who were likely to experience personal loss due to their passage was pretty small.

This may depress those of you who long for a government that soars with ambition, but this is what a bipartisan bill looks like these days: too small to attract much attention from anyone besides wonks and dedicated lobbyists. Can we envision something matching that description that could take the place of the troubled Republican health care proposals?

Yes, just barely. Jettison the ambition and just do one thing: stabilize the individual market by giving money to states to figure out how to shore up their ailing exchanges. It gives legislators a little pork to take home, and solves a real problem. It makes Democrats happy because Obamacare lives to fight another day; it makes Republicans happy because they don’t have to explain to voters how come Obamacare died a horrible lingering death after they took office. It doesn’t do terrible things to the government budget, even if it doesn’t do anything good, either.

Even this seems like a very hard sell in the current partisan environment. And unfortunately for Republicans, “very hard sell” looks like the best of the options they have.

— Read GOP Is Said to Drop Insurance Executive Tax Change in Health Bill on ThinkAdvisor.