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Ex-rivals show way on bipartisan health care fix

“When we started this 18 months ago,” Tom Daschle told me, “we assumed that there could be a grand bargain.”

The former Senate majority leader, a Democrat, laughed ruefully, as did his companions. Daschle was visiting the Washington Post with Republican Bill Frist, also a former majority leader; former Sen. Pete Domenici, longtime head of the budget committee; and Alice Rivlin, former director of the Congressional Budget Office.

Their assumption that Washington might come up with a rational, bipartisan solution to its long-term fiscal challenge now seems almost hopelessly naive.

In the year and a half Daschle referred to, the four former officials had crafted, under the auspices of the Bipartisan Policy Center, a plan to improve U.S. health care while controlling costs. But they no longer had any illusion that it could become one component of a larger effort to increase revenue and tame entitlement programs – to get the federal debt under control.

I asked them why a grand bargain now seemed so far out of reach. President Barack Obama came into office five years ago promising to make hard decisions, not to kick the can down the road, not to let entitlement programs – primarily Medicare, Medicaid and Social Security – swallow the rest of the budget.

Republicans took control of the House in 2010 promising a new era of fiscal responsibility.

Both sides understand that a failure to reform entitlement programs will guarantee more and more funds flowing to a growing elderly population while the future – education, research, infrastructure – is starved.

Rivlin, the only non-politician of the four, offered the least political explanation. A slowing of health care cost growth and a reduction in the federal deficit had relieved the pressure, she said.

“Unfortunately,” she said, “we are reducing the deficit in all the worst ways.”

Discretionary spending (on national parks, health research, Meals on Wheels, law enforcement and just about everything else other than health care and pensions) is coming down too quickly. Meanwhile, Medicare spending, despite some moderation in its growth, remains likely to swell dangerously.

Domenici’s answer was simpler. “It doesn’t seem the president wants to get something as significant as this done,” he said.

“I think it’s going to take presidential leadership,” agreed Frist.

“The president doesn’t want to negotiate with himself,” responded Daschle.

Aha, you may say. Partisanship – even at the Bipartisan Policy Center.

But that, in a way, is the point. Daschle and Frist governed as, and remain, true-blue (or true-red) partisans.

But over the past 18 months they were able to sit together, sift evidence, weigh competing proposals, work with staff from both camps and come up with a unified, intelligent plan to control health care costs.

It’s a plan that goes beyond ideology and buzz words. .

An “enormous amount of institutional intransigence” stands in the way, Daschle acknowledged.

“Practitioners tell us, ‘Yes, you should change the system, but wait until we retire,’ ” Domenici said.

That philosophy fits well with Washington’s, which on most subjects has become: Wait until the next election. Delay allows the politicians to evade any hard calls. It guarantees that fiscal reform, when eventually implemented, will be more painful.

And it rests on two illusions. One is that, if the true believers just wait through one more cycle, they will persuade the country that they are right and the other side is wrong. They will break through to dominate Congress, the White House and soon enough the judiciary as well.

In fact, the United States is evenly divided, and even if one party wins a temporary advantage in the two elected branches, any one-sided solution it rams through will prove unsustainable.

The other, even more dangerous illusion, is that one side’s solutions are all good, the other side’s are all bad and compromise, even if necessary, is by definition unfortunate.

The quartet’s plan for health care offers a useful refutation.

“Bipartisanship does not have to mean watered-down stuff,” Frist said. “It’s really a debate of ideas, and you try to pull out the best from both sides.”

That could be a prescription to fix more than just the health care system.

Fred Hiatt is a columnist for the Washington Post.

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