I don't get it. Two weeks ago, I wrote a column offering advice to Democrats and the White House, saying that they could achieve a broad bipartisan consensus on health care by supporting S. 334, the Healthy Americans Act (HAA), introduced last year by liberal Democratic Sen. Ron Wyden of Oregon and conservative Republican Sen. Bob Bennett of Utah.
Then last week, Sen. Max Baucus, after months of working with the bipartisan "gang of six" Democrats and Republicans on the Senate Finance Committee, introduced a bill that did not attract a single Republican, and more than a few Democratic dissenters.
Yet, as I wrote two weeks ago, the Wyden-Bennett measure already had such Democratic co-sponsors as Sens. Debbie Stabenow (Michigan), Tom Carper (Delaware), Bill Nelson (Florida), Maria Cantwell (Washington) and Dan Inouye (Hawaii); and Republican Sens. Lamar Alexander (Tennessee), who is No. 3 in the Senate leadership; Judd Gregg (New Hampshire), ranking member of the Senate Budget Committee; and Mike Crapo (Idaho), a member of Mr. Baucus' Finance Committee and a Harvard Law graduate. Republican Sen. Lindsey Graham was quoted in The Washington Post that he could vote for the HAA.
And what exactly does the HAA accomplish that could possibly attract such broad, bipartisan support from left to right in the U.S. Senate?
• Universal health insurance coverage for every American - the goal of most Democrats since President Harry Truman first tried to introduce a national health care bill more than 60 years ago, including requiring insurance companies to ensure all, regardless of pre-existing conditions or status of the individual.
• Reliance on choice and competition in the private marketplace - core principles of conservatism.
• Immediate deficit neutrality in the first two years, and then surplus revenues in the years thereafter - i.e., reducing the budget deficit - according to a May 1, 2008, letter sent jointly by the Congressional Budget Office and Joint Committee on Taxation - co-signed by none other than Peter Orszag, then head of the CBO and now President Obama's OMB director.
• Cost-containment measures, using tax incentives and disincentives as well as state-based regulations, to squeeze savings out of the wasteful and inflated $2.5 trillion that Americans will spend on health care this year - enough to pay a doctor $200,000 a year to do nothing but care for every seven families in the nation - savings also attested to by the CBO/Joint Tax Committee letter.
Here's an oversimplified explanation of how the HAA accomplishes all of the above:
• It requires every American to purchase a health insurance policy.
• Any employee whose employer provides health insurance would receive a cash payment equal to the cost of his or her insurance policy (with a comparable tax deduction, so no increased tax liability should result) and from that time on, would be required to use all or part of that extra compensation to purchase his or her health insurance.
• All other uninsured Americans would be required to purchase insurance, but those at or below the poverty level would receive a 100 percent subsidy to pay for all of the premiums, and those at up to 400 percent of the poverty level would receive subsidies on a sliding scale. These subsidies would be paid from a variety of enhanced tax revenues resulting from passage of the HAA.
• All Americans would purchase their insurance from plans listed on state-administered public "Health Agencies" or "exchanges" - with at least one on the public exchange at least as good as the plan available to all federal employees, including members of Congress. And coverage would be mandatory for everyone, including those with pre-existing conditions.
The details are complicated, the core principles are that simple.
Ezra Klein, a blogger formerly of the American Prospect and now with The Washington Post, has written a series of articles in the last year praising the Wyden-Bennett plan.
Mr. Wyden, Mr. Bennett and their supporters "have spent years working with the Congressional Budget Office to get the budget hawks' seal of approval. They have brought the legislation before academics and interest groups, before politicians and business leaders. They have heard concerns and incorporated new features. They have put in the hours. And it was hard, and it took time. But the work was necessary. And it is done."
In June, the Wall Street Journal's highly respected Colin Levy wrote, "The idea, Mr. Wyden says, is to harness the Democratic desire to get everyone covered to the Republican interest in markets and consumer choices."
In August, David Leonhardt, the New York Times' economics weekly columnist, wrote: "The only bill introduced in Congress with real choice is the Healthy Americans Act. The immediate advantage would be that people could choose a plan that fits their own preferences, rather than having to accept a plan chosen by human resources. You would be able to carry your policy from one job to the next or hold onto it if you found yourself unemployed. You would never have to switch doctors because your employer switched insurance plans. The long-term advantage would be that health insurance would become fully subject to the brutal and wonderful forces of the market. Insurers that offered better plans, plans that drew on places like the Mayo Clinic to offer good, lower cost care, would win more customers."
Two weeks ago, on Sept. 4, David Brooks praised the HAA in his New York Times Republican-tilted column because it made "consumers accountable for spending, price information transparency, and reward[ed] health care, not health services" and addressed the "structural problems instead of papering over them. ..."
And in a New York Times op-ed just last Thursday, Mr. Wyden summarized the combination of liberal and conservative ideas that makes his and Mr. Bennett's proposal the most likely to win passage with broad bipartisan support:
"According to one estimate, injecting this kind of competition into the employer-based system would save people and businesses more than $360 billion over 10 years. At the same time, it would improve the quality of healthy care. Americans could take advantage of this change, or ignore it if they like; it would not be forced on them by government mandate. Ultimately, by empowering people to select the health insurance that makes the most sense for them and their family, we could end up with a system that works better for everyone."
In the next two weeks, I will explain in detail how the HAA works - first, the structural reforms in creating universal coverage; and the following week how the HAA accomplishes this while ultimately, according to the CBO, producing surplus revenues, reducing the deficit and creating higher quality health care for all Americans.
• Lanny J. Davis, a Washington lawyer and former special counsel to President Clinton, served as a member of President George W. Bush's Privacy and Civil Liberties Oversight Board. He is the author of "Scandal: How 'Gotcha' Politics is Destroying America." This piece is also published at http://pundits.thehill .com.