They are an odd couple politically: a liberal Democratic Senator from the Pacific Northwest and a conservative Democratic Congressman from the South. But Oregon's Ron Wyden and Tennessee's Jim Cooper are convinced they have the answer to the nation's health-care crisis if only they could get the key players on Capitol Hill to give their radical plan a hearing. "There's a real opportunity for a philosophical truce here that you didn't have in 1993," the last time Washington attempted to overhaul the health-care system, says Wyden. "Republicans, who didn't accept the idea of coverage for everybody in 1993, have moved. Democrats have also moved. There's much more acceptance of giving a wide berth to the private sector."
Maybe so, but the question that Wyden and Cooper's plan raises is whether either side is really willing to completely scrap the current system, under which most people get coverage from their employers. That arrangement is more a historical accident than an efficient design, a legacy of World War IIera wage and price controls, when companies began offering health insurance as a way of attracting skilled workers. Over the years, however, much has changed. Few workers spend their entire careers working for one company anymore, and businesses are staggering under the burden of health-care costs, which have been rising at twice the rate of inflation. (See the top 10 medical breakthroughs of 2008.)
Wyden and Cooper are pushing a drastically different new arrangement under which employers would turn over the money they spend on those benefits to workers, so that employees could purchase coverage themselves from a selection of plans. The idea has a lot of appeal. It would give most people far greater choice than they have now, and they could take their benefits with them when they change jobs. It also provides generous subsidies for those who cannot afford to purchase health care on their own, and yet the Congressional Budget Office has said the proposal would be "revenue neutral," which means it wouldn't add to the deficit. It would include a minimum defined-benefits package, with no exclusions for pre-existing conditions. That would address two problems people now encounter on the individual insurance market, where it is difficult for many to find the coverage they need at a price they can afford. What's more, their bill can boast something no other plan has at this point: bipartisan support. In the Senate, Wyden's Republican co-sponsors include Utah's Bob Bennett, Idaho's Mike Crapo, South Carolina's Lindsey Graham and Lamar Alexander of Tennessee, a member of the GOP Senate leadership.
Wyden and Cooper's approach also has a big following among health-care wonks, among them, noted bioethicist Ezekiel Emanuel brother of White House chief of staff Rahm Emanuel who has been tapped to play a big role in health-care reform in the Obama Administration's Office of Management and Budget. Emanuel and Wyden teamed up in December to write an op-ed piece in the Wall Street Journal on the limits of employer-based health coverage. And though during the election campaign Barack Obama criticized John McCain for proposing a plan that, like Wyden's, would make employer-provided health benefits taxable, the Administration has suggested in recent weeks that it is open to such an approach. (See who's who in Obama's White House.)
Still, Wyden and Cooper's plan is considered a long shot. The political wisdom in Washington suggests that for any proposal to actually stand a chance, it would have to build on the existing employer-based system. For much the same reason, few believe that "single payer" health care a government-financed system similar to Medicare will be given any serious consideration. As one Administration official put it in describing the Wyden plan, "A lot of people think this is where the system should be 20 years from now, but no one sees how it can be there two years from now."
Despite those doubts, Wyden and Cooper continue to lobby the committee chairmen and ranking members of the five panels that have jurisdiction over the issue on Capitol Hill. "We want to be team players," Wyden says. But they also note that time is quickly running out if lawmakers are to meet their self-imposed deadline of having a bill passed out of both chambers before the August recess. So they are watching the informal negotiations that are underway on both sides of the Capitol carefully. All they need, they say, is the right opening. Or at least a seat at the table.