Two smart governors suggest health care
In the spirit of bipartisanship supposedly inspiring a recent Blair House health care summit, I thought I'd seek advice from a knowledge-able group unfortunately not represented -- the nation's governors.
So I interviewed two gubernatorial health-care reformers -- Democrat Phil Bredesen of Tennessee and Republican Mitch Daniels of Indiana.
Coming from completely different views about the ideal health care system, the two agreed on this: Instead of trying for comprehensive reform this year, Congress and the administration should go "incremental."
(Along the way, after urging him to run for president in 2012 as a "conservative who gets things done," I got Daniels to allow that there's a "2 percent chance" that he might.)
Bredesen and Daniels each have a standing on health care. Both were top-level health care executives in the private sector and, as governors, both have fostered reform in their states and invented programs that work.
Bredesen told me that, despite their experience managing Medicaid, "the governors have been shunted aside" in the federal reform process.
He said he was one of four governors deputized by the National Governors Association to talk with the White House, congressional leaders and staff, but "I had the feeling we were a base to be touched, not that they were listening."
Congress and President Barack Obama's "real mistake," Bredesen said, was that "they went way too far toward what some activists think is ideal, with a comprehensive set of benefits that is way too expensive."
He said that current Democratic plans remind him of the TennCare program that he inherited in 2003, which was driving his state into bankruptcy, and which he reformed by cutting benefits and enrollment.
Instead, he said, "you could move forward, the president could get a victory and Republicans could be seen as cooperating on a more limited benefit for a population that everyone agrees is deserving."
He means offering a basic health-insurance package to 20 million workers whose employers do not cover them.
If employers had to contribute 25 percent of the cost, the worker 25 percent and the government 50 percent, the cost would be $430 billion over 10 years, less than half of Obama's latest proposal.
Bredesen instituted a similar plan in Tennessee, called CoverTN, but has funds to offer insurance to only 23,000 of the state's 400,000 uninsured workers.
If Bredesen had his way, the United States eventually would have a universal coverage system like France or Germany, where all citizens are covered in a single, non-means-tested system. But, he said, the United States can't afford that now.
Daniels, as befits a conservative Republican, starts with the opposite view. He favors eliminating employer-based insurance and giving tax breaks to individuals to buy their own policies.
"Which translates into consumer-driven health care. I'm a believer in the idea that until every one is a cost-controller, there won't be cost control," he said.
In the present debate, though, he said, "I'd at least hope that both sides could agree on some incremental changes, including portability of policies, buying policies across state lines and medical malpractice reform."
In Indiana, Daniels has been experimenting with variations on health savings accounts -- much favored by the GOP but hated by Democrats -- to supplement Medicaid.
The Healthy Indiana Plan offers the uninsured a high-deductible ($1,100) insurance policy that covers up to $300,000 in annual medical expenses and up to $1 million over a lifetime.
Participants pay part of the $1,100 into Personal Wellness and Responsibility accounts, known as POWER accounts, with the state contributing the rest. Money saved can be carried over to the next year.
To answer the Democratic objection that people with HSAs avoid preventive care, such services are free in the Indiana plan and 81 percent use them.
The plan covers only 50,000 of 350,000 potential clients because it's paid for strictly by an increase in tobacco taxes. Daniels does not want to create an entitlement that will blow a hole in his state's budget, such as he inherited and painstakingly closed.
Daniels also has offered the HSAs to state employees and an astounding 70 percent are using them. "They are saving fortunes and we are saving tens of millions," he said.
Daniels believes that "limited government does not imply inactive or inert government." To solve the nation's most dangerous problems -- especially the national debt -- "I'd be willing to accept the second or third best answer as opposed to doing nothing while we go over Niagara Falls."
He also believes in having "grown-up, adult conversations" with Democrats and wants the GOP to "present a constructive and inclusive program to the country," enabling it "to govern, not just win the next election."
Daniels said at a press breakfast Tuesday, "I don't plan to (run for president in 2012). I don't expect to do it. I don't really want to do it."
But he told me, "It's about a 2 percent chance I could run." I hope he does.
Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.