NPR's Scott Horsley reports on another proposal that's being sidelined in the current health care debate on Capitol Hill: the "single-payer" health insurance system, which provides universal health insurance coverage in many of the world's industrialized countries.
What would you say about a health overhaul bill that promises to provide health insurance to virtually every American, to add not a single penny to the federal deficit and to claim supporters ranging from conservative Republican Sen. Judd Gregg of New Hampshire to liberal Democratic Sen. Debbie Stabenow of Michigan?
On Capitol Hill, they're saying it doesn't have a chance.
That's the dilemma faced by Sens. Ron Wyden (D-OR) and Bob Bennett (R-UT), sponsors of the so-called Healthy Americans Act.
Despite being the darling of health policy bloggers and the first bill to be certified by the Congressional Budget Office as covering nearly everyone and fully paying for itself, the measure is being roundly ignored by those actually trying to put together a health overhaul measure on Capitol Hill and in the White House.
That's frustrating for its sponsors, who spent years refining its finer points.
The concept is fairly simple. The plan would change the tax treatment of health insurance provided by employers in a way that would likely prompt many, if not most, to stop offering coverage. That appeals to Republicans, who say the current tax-free status of employer-provided insurance is unfair and encourages overuse of the health care system.
But the bill would also require employers to give workers back what they're spending now on health insurance in the form of a raise. Workers would also get new tax credits, and those who were previously uninsured or did not have insurance on the job would get government subsidies.
Everyone would then take that money and be required to buy insurance, from a new, government-regulated marketplace offering an array of private plans that would compete on the basis of quality and price.
Wyden says it only makes sense to start to move people away from the employer-based health insurance.
"Today the typical worker changes jobs 11 times by the time they're 40," Wyden said. "Right now, health coverage today isn't portable. In fact, when you lose your job, you go into something called the COBRA program, which a bunch of us say is the only federal program named after a poisonous snake."
That's a joke — COBRA is an acronym for the Consolidated Omnibus Budget Reconciliation Act of 1985, the law under which the insurance continuation provisions were enacted.
Bringing The Parties Together
Bennett says one reason he thinks the measure hasn't caught on is that neither he nor Wyden is senior enough on the committees charged with writing the health overhaul bills.
"I've discovered that hell hath no fury like a committee chairman whose jurisdiction is being challenged," Bennett said. "They weren't interested in a couple of guys out in the hall."
But Len Nichols of the non-partisan think tank New American Foundation, an early backer of the measure, says there's another reason the bill isn't up for serious consideration. As with single-payer health insurance, it would simply represent too big a change for most people.
"Too many people were afraid of giving up their employer coverage," said Nichols. "It turns out employers weren't as ready to run away from it as some people thought. And unions were deathly afraid of removing it from their ability to recruit and retain workers."
Nichols, however, says Wyden and Bennett have accomplished something major for the health care debate: "They showed you can get Republicans and Democrats around two core ideas: Cover everyone, but be serious about costs."
And Bennett hasn't quite given up on the bill for this year: "We're hoping that when everyone finishes throwing his or her hands up in horror, and saying, 'What do we do now?' the two guys standing out in the hall can say, 'Look, will you let us in the room and let us get in the discussion and tell you what we've done?"