June 18, 2009

Where did we get the idea that the only good health-care bill is a bipartisan bill? Is bipartisanship more important than whether a proposal is practical and effective? And if bipartisanship is a legitimate goal, isn’t each party equally responsible for achieving it?

This week, the health-care debate moved from general principles to the agonizing specifics of how much reform will cost, who will pay, and which groups get what.

If this were a perfect laboratory experiment, Democrats and Republicans would enter such discussions agreeing on core goals and then argue over how to tweak certain provisions and spread the costs equitably.

That’s what Howard Baker, Tom Daschle, and Bob Dole, the bipartisan trio of former Senate leaders, suggested in a report on Wednesday. Good for them. And Max Baucus, the Democratic chairman of the Senate Finance Committee, still hopes to be health care’s Great Compromiser, this era’s Henry Clay, even if the messy particulars slowed his efforts this week.

But there should be no illusions: On health care, the two parties are far apart on the fundamentals.

Most Democrats believe that fixing the system will require increased government intervention to guarantee universal coverage and to contain costs. Most Republicans oppose an expansion of government’s role and believe an even more market-oriented system would pave the way to health care nirvana.

Trying to achieve full bipartisanship by squaring those two views is a recipe for incoherence.

As it is, President Obama and the Democrats have already compromised a great deal. They are not proposing a government takeover of health-care financing, as single-payer advocates would prefer. Instead, they are working within the confines of current arrangements.

That’s why White House Chief of Staff Rahm Emanuel can argue, as he did in a recent interview, that any proposal Obama endorses will inevitably be "bipartisan" because "the policies in the bill will include Republican and Democratic ideas." That’s another way of saying that any health-care bill that passes will expand government’s role but also build on the existing private health care market.

This has not stopped Republicans from charging that Obama favors "socialized" health care run by "big government." And even when the GOP is not using over-the-top rhetoric, the party’s own proposals make clear how far most Republicans are from Obama’s purposes.

On Wednesday, House Republicans unveiled their own health care principles, and Rep. Dave Camp of Michigan said in an interview that their willingness to do so belies the idea that he and his colleagues constitute "the party of ’no.’"

Camp, a key architect of the Republican initiative, is the antithesis of the Rush Limbaugh-style shouters, a cheerful Midwesterner who has engaged in serious legislating, notably on adoption and foster care. And the Republicans’ wish list does include some less-than-sweeping but reasonable ideas (for example, making it easier for children to stay on their parents’ health plans up to the age of 25, and offering new incentives for doctors to go into primary care) that could well make it into a bipartisan bill.

But their core proposals—especially their call to expand health savings accounts and to overturn state regulations in favor of nationwide "association" health care plans—push in exactly the wrong direction by further fragmenting the insurance market.

Doing so might cut insurance costs for those who are not ill, but at the expense of raising the already prohibitive costs for the sick. The marketplace is good at providing options for the well-off and the healthy, but they are not the ones with problems. That’s why Obama wants the government to change the health care market.

What this means is that most Republicans want to take themselves out of the health-care discussion altogether. For reasons of principle as well as politics, they want to rail against the costs of government action and assert—against what I would insist is overwhelming evidence to the contrary—that somehow we can find a way for the market to solve our health-care problems.

Republicans have every right to do this. But they can’t refuse to play the game and then go on to condemn Obama and the Democrats for being insufficiently bipartisan.

It’s one thing to compromise to pick up votes, which one hopes is what Baucus is doing. It’s another to compromise in exchange for nothing at all. The first is bipartisanship with a purpose. The second is the bipartisanship of fools.

(c) 2009, Washington Post Writers Group