A Bipartisan Agreement on Health Care Was Possible in 2009

Readers of this blog have often heard me say that a bipartisan agreement on a health care bill was possible in 2009–driven from the Senate Finance Committee. I have continually made the point that the two sides were much closer than is commonly believed–or partisans are willing to concede.

Every time I post this, the overwhelming reaction is that I am wrong–with one side inevitably blaming the other for a lack of good faith in the discussions.

Bara Vaida had an interview in Friday’s Kaiser Health News with Mark Hayes, who was the lead Republican health staffer on Senate Finance at the time and had a “clear view” of the negotiations.

Here are the key excerpts:

Q: [Vaida] Key Democrats, including Senate Majority Leader Harry Reid, D-Nev., recently said their biggest regret was allowing the Senate Finance Committee leaders, your former boss Sen. Grassley and committee chair Max Baucus, D-Mont., to spend so much time trying to forge a bipartisan compromise on health care. What do you think about that criticism?

A: [Hayes] We really devised much of the health care framework even before the Gang of Six Senate (Finance Committee) leaders started meeting. In the summer of 2008, Sens. Grassley and Baucus held a summit and we were chugging along with planning our roundtables and it is my understanding that the leadership was frustrated with us that we were moving too quickly and they wanted us to slow down. We got agreement on 80 percent of the framework even before the Gang of Six started meeting to take on the remaining 20 percent. People were naturally impatient but the complexity of the job, connecting the dots and making the model work is a huge challenge so those who pushed for it to be done quickly were watching the clock and likely didn’t have a full appreciation for the issues we were attempting to resolve. The idea that the health care law could be done quickly and be done right is like saying you can go to the moon on the first try.

Q: [Vaida] What were the pieces that had been agreed to and what was the remaining 20 percent?

A: [Hayes] We agreed on the structure of the exchanges, state regulation, insurance reform, delivery system reform, the creation of the innovation center and financing mechanism. The last pieces that needed to be resolved and became problematic were the amount of funding, the offsets and the way the individual mandate would be implemented. This was a huge missed opportunity. Partisanship–particularly from the Congressional leadership and the White House–overwhelmed what could have been a bipartisan agreement.

Even then, I doubt any of the players foresaw the degree of political and market uncertainty, as well the national division over the new law, that ramming this thing through has caused.

Why does anyone ever think partisanship is superior to bipartisanship? Yet, a year later the Congress is more polarized than ever with many of the more bipartisan members from 2009, like Bob Bennett of Utah, in forced retirement.

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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6 replies »

  1. It’s hard to say who is more desperate to prove that bipartisanship was possible in health reform, Mark Hayes or Bob Laszewski.

  2. There was essentially zero bipartisanship in the Senate until the lame-duck session. Why would the largest, most historic bill that advances Democratic ideals also be the greatest exception to this? David has a good point: there were several cases where Democrats revised bills in committee to please Republicans who voted for them in committee, but then felt pressure and went with their party on the general vote.
    Wasn’t Grassley making nasty comments to his constituents even while the Gang of Six still lived? Wasn’t Mitch McConnell explicitly saying that making Obama a one-term president their highest priority (and a historic bipartisan reform would have hurt that goal)?
    I’m not buying it. It sounds like the biggest sticking point was really the funding, meaning the subsidies, I take it. If the subsidies were substantially lower for the poor (while penalties remained or were increased to prevent risk pool disasters) it’s hard to imagine that people on the left wouldn’t defect in droves.

  3. This account of what happened in finance is not consistent with the positions republicans actually took. For instance, on the mandate, the difference between the dems and reps isn’t a matter of details–the republicans claim to be ideologically opposed (and never mind they supported it until 2009). The issue is not implementation, it is the existence of the mandate. I mean, “unconstitutional” is not short for “i like it in theory but think we need to tweak the enforcement mechanism a bit.”
    By august, grassley was warning us about plans to “pull the plug on grandma.” That is not rhetoric its easy to later back away from.
    The mistake baucus made was thinking he could win over republicans with decent policy. The issue was not policy, it was politics. Republicans had an enraged, rabid base, and compromise with ANY plan was anathema to them.

  4. The entire thing–the Baucus plan, basically written by as right wing a Democrat as you can imagine with a former Wellpoint employee drafting it–got precisely one Republican vote in Committee once (Thanks, Olympia Snowe). And she was forced PDQ to change her mind when she heard from the right wing of her her party and saw what happened to Bob Bennet.
    On what planet was any bi-partisan bill that did anything substantive (E.G got us even vaguely on the road to universal coverage) possible?
    The Democrats would have been politically better off never bothering to even pretend and to force through a much more left wing bill that pleased their base and got some of them out to vote in 2010. They only lost the house by 3 million votes. Obama beat McCain by 10 million. The difference was the uninspired 2008 Obama base staying home.

  5. I am inclined to take this with a grain of salt. Mr. Hayes has a POV here that we cannot assume is objective.

  6. I dunno, Bob. I’m glad the worker bees in Senate Finance thought an agreement was close, but the larger political dynamic of the 111th Congress — in particular, the supermajority requirements imposed by Senate Republicans and the unanimous rejectionism that characterized the party — suggests that all that work still would have gone for naught even if the committee had produced a bipartisan draft.
    I mean, how many times did we see Republican legislators insist on compromises and then vote against the amended bill? How often did we see ideals like the individual mandate, originally proposed by conservative analysts and championed by conservative politicians, denounced (as unconstitutional!) by Republican leaders? What do you make of the Senate “moderates” who would support Democratic bills in committee and then find spurious reasons to vote against them on the floor?
    Bipartisanship is all well and good, but it shouldn’t be a suicide pact, as it likely would have been for healthcare reform.
    As an aside, would now be an impolitic time to remind folks that you used to routinely predict that there was no way, no how that reform could pass on a party-line vote?