Health care next steps: Fast track, slow track, no track?

There are endless analyses of yesterday’s health summit, all of which probably add as much to the debate as the meeting itself. To wit: No one is changing his or her mind because of the talk-fest.

(One common reaction — see an example here from Slate, not exactly a hub for right-wingism — that I do find interesting is the idea that Obama and the GOP delegation both came out looking better than the congressional Democrats. That strikes me as either an acknowledgment that Republicans exceeded expectations, or that Democrats may have passed a bill a long time ago if they had better leaders in Congress; feel free to discuss below.)

If minds weren’t changed, though, I have come across one particularly interesting suggestion for a next step forward. Here’s Arnold Kling of George Mason University’s Mercatus Center, writing at National Review Online:

I thought that President Obama did well to convey a willingness to negotiate. If I were the Republicans, I would move off the “scrap the bill” talking point and instead go with something like this:

We have some areas where we agree, some areas where we might negotiate, and some areas where we can never agree. That suggests a three-track approach.

1. Fast track. For issues such as ending waste, fraud, and abuse in Medicare, we should aim to pass a bill within 30 days that contains all the ideas on which we agree.

2. Negotiation track. These would be issues where compromise is possible. For insurance competition, the president expressed concern that allowing interstate sales of insurance could cause a “race to the bottom.” That may be a legitimate concern, but it is hypothetical. Instead of preemptively regulating the insurance industry, why not try the Republican approach and see what happens? Meanwhile, create a competitive-practices board for the insurance industry that would monitor the industry and issue public reports on abusive practices. Congress could later vote to convert this board into a permanent regulatory board if public pressure demands it.

I would put the Medicare-cost commission on the negotiation track. But I have long been more willing than most Republicans to endorse doing cost-benefit research on medical procedures.

In principle, the issue of expanding insurance coverage can be put on the negotiation track. But if I were a Republican legislator, I would take a hard line against funding expanded coverage with budget gimmicks, enforced cross-subsidies, or Medicare cuts (again, not that I am against Medicare cuts, but they need to be applied to improving the financial health of Medicare). I would take a relatively softer line against funding more coverage with taxes in an above-board way.

3. Gridlock track. Issues like public funding of abortion or malpractice reform probably go here. Agreement and compromise are not likely.

For all I know, Kling has been calling for such an approach for some time now. But it strikes me as an idea that has found its moment. It’s exactly what I have meant in calling for starting over.

What would you put on the “fast track” versus the “negotiation track”? (And please don’t suggest “tort reform” or the “public option” for the fast track — knowing full well that those polarizing ideas are exactly what we’re trying to distill from the more commonly accepted ideas.)

91 comments Add your comment

StJ

February 26th, 2010
10:37 am

Well, this won’t happen because it makes too much sense. It appears that the Democrats are going use the ‘nuclear option’ to pass it.

But yes, in a perfect world, getting rid of the waste should be a no-brainer.

Jefferson

February 26th, 2010
10:41 am

So having the majority is nuclear ?

misplaced

February 26th, 2010
10:45 am

It’s called “Reconciliation” not the ‘nuclear option’ and was used by the Repukes during the Bush years. Now they call it ‘Chicago Style Politics’ because someone else gets to use it.

LA

February 26th, 2010
10:49 am

“It’s called “Reconciliation” not the ‘nuclear option’ and was used by the Repukes during the Bush years. Now they call it ‘Chicago Style Politics’ because someone else gets to use it.”

Do you always get your misinformation from Keith Olbermann?

Horrible Horrace

February 26th, 2010
10:50 am

Put the entire OboboCare on the SideTrack.

misplaced

February 26th, 2010
10:51 am

No LA I do you get all your info from Rush and FAUX news? What I stated was a fact look it up.

CJ

February 26th, 2010
11:01 am

South Dakota, Delaware, and the credit card industry have demonstrated exactly what will happen if insurers are simply allowed to sell insurance across state lines without federal standards. One or two states would see this as an opportunity to create jobs in their state, and so reduce insurance regulations significantly to attract health insurers. Of course, the insurers will locate in those one or two states in order to sell us policies with fine print that allows them to deny even more claims.

Research shows that 45,000 Americans die every year because of lack of health insurance (that’s more than 9/11 level casualties every month).

Researc also shows that 62 percent of bankruptcies are caused by medical expenses and 78 percent of these bankruptcy filings are by people who had medical insurance when they first got sick. So, even if we’re currently covered (and like our insurance), the limits of coverage are terribly inadequate in the event of a major accident or illness-and that’s assuming the insurance company doesn’t arbitrarily deny coverage for what ails us.

The GOP controlled the White House and Congress for years, and did nothing. Now, when both the House and Senate have passed a bill for the first time in history, and all we need is a conference bill to pass, the GOP wants to “start with a clean sheet of paper.” The evidence clearly shows that Republicans don’t want health care reform at all (so-called “tort reform” in which they take away the rights of legitimate malpractice victims is not health care reform).

We need to eliminate the insurance company practice of denying coverage to those with pre-existing conditions today; we need to eliminate the insurance company practice of rescission today; we need to eliminate caps on coverage today; and we need to find a way to keep insurers from gouging us. Of course, neither of these things can be accomplished without mandates–something that Republicans were for until Obama signed on.

In short, my answer to Kyle’s question is fast track.

Churchill's MOM

February 26th, 2010
11:12 am

This makes far too much sense for the “Leaders” of the RINO party to follow after all neither sides cares about the taxpayer.

RJ

February 26th, 2010
11:13 am

Kyle, I’m wondering if you think the Republicans wanting to start over is because they actually think the bill is bad, or because it would delay passage until after the midterm elections when they believe they can regain a bunch of seats.

If I was the Republicans in Congress, I’d stop trying to deal with any Democrat in Congress and do all my negotiating with Obama. Obama seems to understand that a President’s effectiveness is directly tied to their willingness to work with the other party. The Dems in Congress don’t. I’m not saying it would work, but it’s certainly a better chance.

No More Progressives!

February 26th, 2010
11:27 am

The economy is in the doldrums, real unemployment is about 18%, the Fed is printing money as fast as the press will go, and Iran is getting ready to detonate a test warhead.

Others, far smarter than I, tell me their take on health care overhaul may not pass the Constitutional smell test.

This patient is in bad shape; severe head trauma, bleeding and airway restiction. And we’re worried about the manicure…………………….

And our ships Captain has never even rowed a rowboat.

Horrible Horrace

February 26th, 2010
11:32 am

“Others, far smarter than I, tell me their take on health care overhaul may not pass the Constitutional smell test.”

Yup…let the lawsuits begin to fly!!!

YEA BABY!

No More Progressives!

February 26th, 2010
11:49 am

Horrible Horrace

February 26th, 2010
11:32 am

Yup…let the lawsuits begin to fly!!!

YEA BABY!

Yeah……….that’ll really help a lot, won’t it?

retired early

February 26th, 2010
11:50 am

CJ
The GOP do not care if 45,000 die annually or that 62% of BR are due to medical expenses. As long as they have their insurance. The fact that they claim the moral high ground is a joke.

Jim Donohue

February 26th, 2010
11:53 am

I am a democrat, but I too was surprised how bad the democratic leaders appeared, particularly Reid and Pelosi. Reid seemed really mean and inarticulate. Is there a senility issue here? Pelosi just seemed completely dishonest – all of her comments were ‘political spin’ over substance.

Gramps

February 26th, 2010
11:59 am

Hey, Jim Donohue – Welcome to the Republican party. That is what we have thought for a long time.

John D. Froelich

February 26th, 2010
12:08 pm

Whatever4 is rammed thru can be repealed if tht is what the voters set upin Nov.

LA

February 26th, 2010
12:30 pm

“I do you get all your info from Rush and FAUX news? What I stated was a fact look it up.’

1: Grammar fail.

2: I get my information from a lot of different sources.

3: You made the claim. Back it up.

Bottom line: Why does Rachel Madcow dress like a teenage boy?

LA

February 26th, 2010
12:31 pm

“Reid seemed really mean and inarticulate. Is there a senility issue here? Pelosi just seemed completely dishonest – all of her comments were ‘political spin’ over substance.”

SEEMED????????? Both of those people are some of the DUMBEST people on the planet.

LA

February 26th, 2010
12:32 pm

“What I stated was a fact look it up.”

You made the claim. Back up your claim.

LA

February 26th, 2010
12:33 pm

PMSNBC is saying that yesterdays waste of taxpayer money was a tie between the GOP and the democrat party.

Whenever liberals say that a debate etc. was/is a tie, it means that the GOP beat their a$$.

LA

February 26th, 2010
12:35 pm

“I’m wondering if you think the Republicans wanting to start over is because they actually think the bill is bad, or because it would delay passage until after the midterm elections when they believe they can regain a bunch of seats.”

Quick answer: the bill is horrible, not bad, and they also know that the American people do NOT want a public option nor do they want the government to run the health care system.

kayaker 71

February 26th, 2010
12:45 pm

Articulate, honest negotiations? Getting to the bottom of the health care dilemma? Give and take idea sharing? What a joke!! The crowning comment that displayed the greatest attempt at responsible dialogue?…… “The election is over”. Look inward, Bozo. The campaign is over and the American people are expecting someone to step forward and start to govern. Bozo, you have been on the campaign trail since Jan 20, 2009. We keep waiting for you to get your chin out of the air, assume some humility and answer to the electorate. But, no, your “vision of America” will either survive or you will go down in flames in 2012, all the time maintaining that you know better what is best for America than the electorate. Man, do you have a lot to learn.

Jim

February 26th, 2010
12:48 pm

retired early
“The GOP do not care if 45,000 die annually or that 62% of BR are due to medical expenses. As long as they have their insurance. The fact that they claim the moral high ground is a joke.”

This is the kind of remark being made by both sides of the table that help nothing and no one. Nobody wants to see people die and to say they do is ridiculous as stated by [url=http://www.youtube.com/watch?v=fRdLpem-AAs] Reagan[/url]

It is clear that our healthcare system has issues and it is also clear those issues need re-vamping. I would hope that this is obvious to anyone who breathes. Because this is obvious, then there should be some things we can at least talk about, hence the “Negotiation Track”. I think this is a great place to begin AFTER going over those things which both sides are in agreement with, even if those points are few. Under this point of negotiation the implementation on bringing down the cost and providing coverage for those in dire need could be negotiable. This is what could potentially make or break the bank.
Those things which are obviously agendas for either party should simply be removed and dealt with elsewhere. One could say that sort of logic could be used on the whole bill but that is not my point. Adding programs in fine print is simply shady. Make this thing as simple, clear, and concise as we can so that we can move on, please!

misplaced

February 26th, 2010
12:59 pm

OK LA

MCCAIN: “I fully recognize that Republicans have in the past engaged in using reconciliation to further the party’s agenda. I wish it had not been done then, and I hope it will not be done now that the groundwork has been laid. ”
The repukes have used it many times, more so then the dems. That LA is a fact…

hank

February 26th, 2010
1:00 pm

LA’s off his meds, he’s become unhinged….

feeling cheated

February 26th, 2010
1:03 pm

I don’t think LA comments nearly enough times, and it’s just not fair. Is Kyle deleting some of LA’s much anticipated comments out of sheer unadulterated jealousy and spite?

Please give more of yourself, LA, you’re the only reason anyone reads the ajc online. We get plenty of the other guys that nobody wants to read. We need more you.

LA! LA! You go! You go! You rock! You rock! La! LA!

Hooray 4 LA!!!!

Horrible Horrace

February 26th, 2010
1:05 pm

“Yeah……….that’ll really help a lot, won’t it?”

Almost anything to defeat this ill-conceived notion that HCare is a RIGHT is ok by me. Hopefully, the State Attorneys will muddy up the waters, toss a monkey wrench in the machinery…anything to draw this out and defeat it.

Jess

February 26th, 2010
1:12 pm

retired early,

45,000 deaths annually claim was rebuked the first week the Florida dem congressman made. Even the two who did the study he cites admit their work was not meant to and cannot predict deaths for lack of insurance. This is why you never hear politicians use the number. If there was a shred of evidence, the dems would be all over it.

No More Progressives!

February 26th, 2010
1:22 pm

Horrible Horrace

February 26th, 2010
1:05 pm
“Yeah……….that’ll really help a lot, won’t it?”

Almost anything to defeat this ill-conceived notion that HCare is a RIGHT is ok by me. Hopefully, the State Attorneys will muddy up the waters, toss a monkey wrench in the machinery…anything to draw this out and defeat it.

In that case, I’m 100% behind you. I just misread your first post.

Hillbilly Deluxe

February 26th, 2010
1:29 pm

ending waste, fraud, and abuse in Medicare

I’m just an old country boy but couldn’t that be taken care of without passing a new law? I’d think fraud and abuse would already be illegal, and waste is a management problem.

CJ

February 26th, 2010
1:35 pm

Jess’ approach to political debate is similar to that quote from that Lewis Carroll poem. “I have said it thrice: What I tell you three times is true.”

I’m sorry, but saying it doesn’t make it true. I linked above to the Harvard website where the research was conducted by several researchers. Here’s a quote from one of those researches (see link in my previous post).

“The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance,” remarked David Himmelstein, study co-author, associate professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance. “Even this grim figure is an underestimate — now one dies every 12 minutes.”

Andy

February 26th, 2010
1:57 pm

Rising health care costs are the issue. We need to find as many low cost solutions as possible that measurably reduce costs significantly; i.e. find solutions with an extremely high cost benefit ratio.

For example, establishing check lists to reduce medical errors, making nutrient rich food less expensive and nutrient poor food expensive, moving away from a diet of fast food, excessive sugar and pizza, giving people time in their lives to get the correct amount of exercise and sleep, changing out commuting patterns so that we live near where we work, eliminating 60-70 hr work weeks, etc. These solutions require very little government funding but have enormous paybacks.

We also could start sending low income people to community health centers instead of the emergency room for routine care. And encourage doctors to practice there in return for reducing their student loans.

We could make sure that minor illnesses don’t become major ones by treating them while they are still small.

LA

February 26th, 2010
2:03 pm

“The repukes have used it many times, more so then the dems. That LA is a fact…”

????? Ok, Olberma’am. Did the GOP ever pass something that the majority of Americans hate?

“LA’s off his meds, he’s become unhinged…”

How so?

“Please give more of yourself, LA, you’re the only reason anyone reads the ajc online. We get plenty of the other guys that nobody wants to read. We need more you.”

Awe, poor whittle wib.

sam

February 26th, 2010
2:09 pm

I don’t think Republicans are interested in any kind of health insurance reform at all…they just want to stall and delay. The Democrats need to wake up and just pass the health care bill with or without Republican support even if the have to use reconcilliation or the “nuclear option”. All this talk by the right that the American people don’t want this bill is bull, Obama won the election fair and square and one of the most important items of his platform was health care reform. Some Democrats need to just quit being scraty cats and lead who cares if they step on a few special interest toes.

No More Progressives!

February 26th, 2010
2:12 pm

Dr. Charles Krauthammer, a man I respect, gives his take on yesterday’s “summit.”

http://www.breitbart.tv/krauthammer-obama-has-given-up-the-aura-of-the-presidency/

Enough said.

No More Progressives!

February 26th, 2010
2:15 pm

“Some Democrats need to just quit being scraty cats………..”

Scraty cats?????

“All this talk by the right that the American people don’t want this bill is bull……..”

Really? Do you live in a cave somewhere? Read any polls lately, or just the ones you agree with?

LibraryJim

February 26th, 2010
2:16 pm

Talk times:
Obama 119 minutes
21 Democrats 114 minutes
17 Republicans 110 minutes (allotted time)
——————-
total Democratic Party talking tally: 233 minutes,

Yep, they really wanted to hear what the Republicans had to say. :roll eyes:

Obama:”You’re right, there was an imbalance on the opening statements because – I’m the president. I didn’t count my time in terms of dividing it evenly.”

Linda

February 26th, 2010
2:28 pm

This is what should be put on the “fast track.”
* Issue a moratorium on paper in both the legislature & at the Federal Reserve, except for sticky notes, in an effort to finally “save the planet,” the dollar & all printing equipment.
* Conduct a mandatory one-day refresher course on the US Constitution & Bill of Rights for Congress & the White House, including all czars, conducted by the Supreme Court.
* Conduct a combination math/tax seminar for the same, conducted by the CBO.
* Require that all members of Congress & the president attend at least 2 or 3 televised Town Hall meetings in their respective districts & states (the president attending in DC) on the Ides of March or on the occasion of the next full moon, whichever comes first, with attendees chosen by lottery, not political affiliation.
* Require all the DC bunch assist in making signs for the Tea Parties in their areas, as a community service project.
* Turn all the government thermostats down to 55 degrees until summer at which time, turn them up to 90.
* Move the Nov. elections up to July 4, Independence Day, & the change-over to July 5.

sam

February 26th, 2010
2:29 pm

exacly, Mr. or Mrs. no more progressives, I just read the poll numbers I agree with because it’s all about how you ask the questions anyway…good leaders don’t govern by poll numbers they do what is right for the country.

RH

February 26th, 2010
2:48 pm

sam – get out of the house and go talk with THE PEOPLE – you’ll be in for a rude awakening. Many that voted for Obama are against this CURRENT version of heathcare “reform”.

RH

February 26th, 2010
2:52 pm

“Democrats need to wake up and just pass the health care bill with or without Republican support”

Hello sam, YOU need to wake up! Haven’t you heard, there are actually DEMOCRATS don’t want Obamacare! You REALLY need to get out of the house and engage in intelligent converstions!

JF McNamara

February 26th, 2010
2:56 pm

I say do reconciliation and pass it. Let Obama bet his Presidency on it. If we need to go back to our current system, we can.

Intown

February 26th, 2010
3:09 pm

If I were to believe Jon Stewart, I would think that these guys at the summit actually discovered some common ground — jerks like Eric Kantor notwithstanding, and that the sensationalist media just cannot put their cynicism and ratings aside for one moment to cover the real story (a substantive debate) rather than spinning this into a political horse race story. But, I know better. The Republicans will continue to hold out until the polls show that the American people want progress on health care legislation more than they want to take their anger out on on the straw bogeyman and elect whoever is not an incumbent.

confused

February 26th, 2010
3:10 pm

sam

February 26th, 2010
2:29 pm
exacly, Mr. or Mrs. no more progressives, I just read the poll numbers I agree with because it’s all about how you ask the questions anyway…good leaders don’t govern by poll numbers they do what is right for the country.

uhhhh, i thought they were elected to represent the people who voted them in, not pass legislation against the will of their constituents??? that’s how our republic works…….they are there to represent the will of the people, not party politics,and the people DON’T want it!!!!! so yes, i think they should be looking at polls………….

RH

February 26th, 2010
3:18 pm

sam says – “good leaders don’t govern by poll numbers they do what is right for the country.”

So sam, are you actually admitting in this statement that your version of “polls” doesn’t exist? Please sam, help me to understand your way of thinking.

Steve

February 26th, 2010
3:18 pm

Linda@2:28 – I would suggest adding that ALL non-military federal government employees (Congress especially) must use the same healthcare plan and retirement plan (e.g. Social Security) as the rest of Americans.

Williebkind

February 26th, 2010
3:25 pm

Hey forget healthcare reform! If you can not pay for medical doctors then go online.

Just in: Senate votes down the unemployment benefits extension. Republican Senator Jim Bunning, Kentucky blocked the extension saying that the $10 billion bill would add to the budget deficit.

I love that man!

RH

February 26th, 2010
3:36 pm

sam! Come back! I believe you! Those poll numbers came from people exiting the bus on election day, you know the ones that you picked up for the bus ride to the voting booth!

Intown

February 26th, 2010
3:37 pm

Blocking unemployement benefits because it adds to the budget deficit … nice. I hope he enjoys the constituent calls on that one!

Just heard that Dems will try to push through the Senate healthcare bill via reconciliation. Guess they finally grew a pair. Why they allowed this debate to go on for nearly a year is beyond me.

RH

February 26th, 2010
3:40 pm

“Obama won the election fair and square” – sammy