In an effort to jump-start health care reform, President Barack Obama has scheduled for later this month a televised summit with congressional leaders from both political parties. It could be worthwhile if it comes off, but expectations should be tempered. Obama should hold firm in refusing to start from scratch, and Republicans have to offer more than they are proposing for any reasonable consensus to form.
The president restated the basic goals in a news conference this week. He's open to all proposals that will "help us get on a path of fiscal sustainability," provide adequate protection against insurance industry abuses, and make "coverage affordable and available to the tens of millions of working Americans who don't have it right now."
Republicans are light on specifics, but the principles of their market-based plan do not come close to creating a path to the president's reasonable goals. Marketplace competition in private health insurance is essentially the current model, and it is unaffordable and unsustainable.
The House and Senate plans developed by Democrats are not perfect. Neither one would do enough to control costs. But they would cover 30 million uninsured or more through individual mandates, expanded Medicaid and federal subsidies for the purchase of health insurance for low- and middle-income families. Republicans object to those initiatives and oppose any obligation on employers to cover their workers. Their plan would probably remove only a few million from the ranks of the uninsured.
Republicans harp on the cost of defensive medicine practiced by doctors to avoid medical malpractice lawsuits. They propose new federal limits on noneconomic damages in those suits. The Congressional Budget Office says this would save $54 billion over 10 years. It's fine for the issue to be raised, but it will not solve the problem and poses risks to patients who are harmed.
The Republican plan also includes allowing insurers to sell policies across state lines, expanding high-risk pools or reinsurance for people outside group plans with pre-existing conditions, and allowing small employers to band together to buy group insurance through their trade associations. But these modest offerings do not add up to comprehensive health reform. Some are ideas that have already been tried, without much benefit. For example, Cover Florida is the Sunshine State's feeble attempt at having the private insurance market cover a major portion of the state's 4 million uninsured. The cost of the insurance and the limited coverage has led only about 4,000 people to enroll statewide.
Republicans and Democrats are so far apart that any agreement is at the margins, such as requiring health insurers to allow parents to cover dependant children through age 25. Even a proposal to allow insurers to offer their policies nationwide, which in limited form exists in the Senate Democrats' plan, would be a disaster if implemented without strong federal regulations of the type Republicans reject. They would allow insurers to offer stripped-down policies, bypassing state consumer protection laws and unleashing a race to the bottom. People would end up with coverage that disappears when it's needed most and have nowhere to turn for help.
The health care summit is another opportunity for Republicans to participate in tackling one of the greatest challenges the nation faces. The president and congressional Democrats should be open to good-faith efforts to make health care more available and affordable. But ambitious goals should not be sacrificed for a weak compromise and a hollow show of bipartisanship.