The Daschle-Dole Health Care "Compromise"

Today, former Senate Majority Leaders Tom Daschle and Bob Dole unveil a bipartisan health care reform plan that they're billing as a "compromise" between GOP and Democratic health care principles.

The root of the plan is a reformulation of the incentives that guide our health care system. The delivery of health care would be tied closely to pay-for-performance initiatives; payments for low-value services would be reduced. Community-based "chronic health teams" would be dispatched to at-risk areas to provide care for those with chronic care. Over time, these delivery reforms -- so far unspecified -- would be integrated into medical education for health professionals. The leaders say they'd realign reimbursement in federal programs to patient outcomes over time.

There'd be an individual coverage mandate; insurance companies would be required to cover everyone and there would be limited variation of premiums, although patients would be able to alter their premiums in exchange for "healthy behavior," like losing weight.  There'd be lots of tax credits for employers and municipalities who implemented wellness programs that worked.

 There's no "public plan" per se, but there'd be a "federal fall back" if the insurance companies didn't or couldn't implement cost-cutting and efficiency measures on their own.

An accompanying television ad urges partisans to "cross the line."  To pay for their health reform proposal, the leaders (capitalized in a preview document as the Leaders, which makes me think of North Korea for some reason) propose $1 trillion in specific savings and then give Congress a choice of either designing a budget trigger to automatically implement cuts if needed or, revenue enhancements.

Premiums would be limited to not more than 15% of out of pocket expenditures and those earning up to 400% of the poverty level would be eligible for subsidies.

An independent Health Care Council would promote coordination among federal health programs, issue cost-cutting recommendations to Congress, and reform medical liability laws. (They sort of punt on the specifics of this last piece.)

It may be too late to effect the debate in Congress, but the Leaders, along with funding provided by the Robert Wood Johnson Foundation, plan to run television advertisements in support of the idea of Democrats and Republicans working together.

Presented by

Marc Ambinder is an Atlantic contributing editor. He is also a senior contributor at Defense One, a contributing editor at GQ, and a regular contributor at The Week.

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