Harold Pollack is a public health policy researcher at the University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies. He's been a regular contributor to the Treatment. As the healthy policy debate heats up, we hope he will contribute even more regularly. And so we've named him the blog's first Special Correspondent.
Among those who favor health reform, commentators seem divided between those who see promise or peril in the search for bipartisan health reform. I am firmly in the "peril" camp. I fear that the pursuit of bipartisanship for its own sake will produce a more costly, less progressive, more rushed, and less carefully-crafted bill. Ted Marmor once pointed out one further irony: The search for politically moderate compromise generates organizationally radical proposed solutions whose very complexity creates further political and policy problems. I do this stuff for a living, and I still don't understand how Senator Conrad's Co-ops would really work. The same goes for many Rube Goldberg compromises now being floated as 11th hour alternatives to a public plan.
According to yesterday's New York Times/CBS News poll, 72 percent of Americans favored "the government's offering everyone a government-administered health insurance plan like Medicare that would compete with private insurance plans." People like the public plan for many reasons. One shouldn't be discounted: They actually understand what that is, who would operate it, and how it would work.
As Paul Krugman noted on Monday, nearly three-fourths of the American public are markedly to the left of the self-avowed Senate centrists trying to impose themselves as the brokers of health reform. As I railed in an email to friends, this is especially true of the "Coalition of the Willing" that Montana Senator Max Baucus has assembled on health reform. This group--Iowa's Chuck Grassley, New Mexico's Jeff Bingaman, North Dakota's Kent Conrad, Utah's Orrin Hatch, Maine's Olympia Snow, and Wyoming's Mike Enzi, and Baucus--resides nowhere near the political center of the broader American public.
Then again, the seven states they represent are incredibly unrepresentative of American society. These have a combined population of less than 11.2 million, markedly less than greater Los Angeles. They include no major metropolitan areas. Their total population is less than 2 percent African-American, almost one-seventh the proportion in the U.S. population as a whole.
According to the Center on Budget and Policy Priorities, the economic and budgetary challenges facing these seven states also do not mirror the nation as a whole. Baucus, Conrad, and Enzi represent the only three states in the nation now running budget surpluses. Three of the remaining states (Iowa, New Mexico, and Maine) face markedly smaller deficits than the national average. Only Utah faces a significant current shortfall.
Bleeding Medicaid budgets provide some of the most pressing arguments for health reform, particularly in large states bearing heavy burdens for the uninsured. It's not very surprising that senators whose states do not face the same pressures view this problem with less urgency.
The Coalition of the Willing won't produce a cheaper or better or even more popular health reform. The opposite is more likely. The saddest thing here: These seven senators may be absolutely right that they can make or break what gets through the United States Senate.