Rethink health care

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America nears a tipping point on health care policy as 2008 begins. The signs are abundant, yet not always clear and connected. Major health care reform, however, represents one of those epic issues requiring extraordinary consensus and bipartisan muscle to lift over the finish line. Unlike some other narrower issues, reform in the wide-reaching area of health care policy will wither absent bipartisan irrigation and deeper conversation with voters.

So, while Iowans cast the first votes on the road to the White House today, polarizing presidential stump speeches filled with health care promises won't do the trick. Before Congress can enact big transformations, citizens need more information and transparency about how the system works and their personal responsibilities to improve it. That education process is underway, particularly in state capitals across the country. And the faster it occurs, the more likely lawmakers can cobble together the necessary political consensus to overhaul the system.

Consider the growing trends in public opinion. Many polls over the last year have ranked "health care" as the most important domestic issue. A survey by the Kaiser Family Foundation released last month provides the latest data point in a growing volume of evidence — it places health care just below Iraq as the issue most capturing public concern.

Yet specific reform ideas receive more mixed reviews. For example, many polls demonstrate support for requiring that all Americans have insurance. But that's probably because 85 percent of Americans already have some type of coverage. Framing the question differently and asking if citizens support a system that requires them to purchase insurance individually rather than through an employer, causes support to drop. As is often the case with polling on public policy, numbers shift significantly depending on how the survey explains the costs and benefits.

Presidential campaigns — particularly among the Democrats — reflect this intense interest in health reform. Unfortunately, in this highly charged political season, many only focus on scoring political points rather than outlining a realistic plan for success. Major health care legislation cannot pass Congress if it's simply ripped from the playbook of partisan presidential campaigns. Successful reform ideas require combining a sound policy proposal with a realistic plan to navigate the political process.

One of the best examples of lawmakers trying to do just that is the Healthy Americans Act, developed by Sens. Ron Wyden of Oregon and Robert Bennett of Utah. The legislation holds individuals responsible for purchasing and owning their own health insurance. Uncoupling insurance from employment could salve the anxiety of many who worry that losing a job means forfeiting insurance. The Wyden/Bennett bill also encourages citizens and health care professionals to focus on prevention rather than just intervening when people get sick — another key reform concept.

The legislation enjoys support from a broad bipartisan group of lawmakers, including Sen. Charles Grassley of Iowa, the senior Republican on the Senate Finance Committee, and Sen. Judd Gregg of New Hampshire, a respected conservative and ranking Republican on the Senate Budget Committee.

But these are big changes on an issue of great salience to Americans. Scrapping the current employer-based model is probably the right medicine for what ails our health care system. Encouraging wellness and prevention — as opposed to paying providers only to treat sick people — is another important step. Yet convincing Americans to eliminate employer-based health care also requires more education. If Americans believe the new approach burdens them with new costs, responsibilities and uncertainties, it's likely to fail. That's why more time and transparency may hold the key to successful reform. Highlighting some of the underlying imbalances in the current system — that employers currently can deduct the cost of health care from their taxes, but individuals cannot — and that more choices will save citizens money and allow them to pick a health care plan that best fits their needs — will help promote the passage of reform.

Achieving broader consensus requires a national conversation — not partisan invective. Today's presidential campaign proposals sound more like marketing plans for candidates in primaries than strategies to advance legislation in Washington. That's why Mr. Wyden and his colleagues deserve commendation. They propose big changes in American health care, transformations that will take time and shake up the current system.

They also realize that soothing American anxiety about the enormity of these reforms requires more public understanding. And that happens by locking bipartisan arms, not crossing political swords.