Health Care's Odd Couple

By Ezra Klein, The American Prospect. Posted March 18, 2008.

Set next to each other, Sens. Ron Wyden and Bob Bennett are a bit of an odd couple. Where Wyden is friendly and effusive, Bennett is deliberate and contemplative, with an almost funereal air. Where Wyden hails from bluish Oregon, Bennett comes from Utah, the reddest state in the union. Where Wyden made his way into politics by forming the Grey Panthers, a legal aid group for the elderly, Bennett's father was a senator and he himself has served as everything from legislative liaison in the Department of Transportation to director of public relations for one of Howard Hughes' companies. Indeed, they appear to have only two things in common. They're both tall. And they want to solve America's health-care crisis.

The latter is what brought me to St. Joseph's University, in Philadelphia, Pennsylvania, for a performance of the Ron and Bob Health Care Road Show. Wyden, smiling broadly, started things off. "Isn't this great?" he enthused. "A Jesuit university hosting a Mormon fellow and a Jewish fellow to fix health care!" It's not their choice of temples, though, that made their joint appearance on stage so surprising. It's their ideologies.

Occasionally, you see bipartisan groups where the various members talk like one another, either because they don't actually disagree or because they're more interested in the deal than in the issue. Not so here. Wyden is a genuine liberal, the type of senator you could imagine voting in favor of Medicare-For-All. And Bennett, who began his talk with a quote from David Frum's new book on renewing conservatism and explained that "my fundamental position is that markets make better decisions than governments do, if they are free to work," is the type of senator you could imagine filibustering Medicare-for-All. And yet, Sens. Wyden and Bennett have co-sponsored health-care legislation that now has 12 senators onboard -- six of them Democrats, six of them Republicans. Wyden, marveling over the strange bedfellows, asked the Congressional Research Service to run a historical search. His suspicions were right. With only 12 percent of the United States Senate onboard, it's the largest bipartisan coalition ever assembled around a concrete piece of universal health-care legislation.

What's remarkable, though, is that Wyden and Bennett, working together, have come up with a bill that is more far-reaching, and more fundamentally transformative to our health system, than anything offered by the presidential candidates.

Our employer-based health system is a costly mistake, the outgrowth of World War II-era wage and price controls and tax breaks that let newly flush employers shield their profits in benefits and escape taxation on health spending. Even today, employer spending on health care is tax deductible, while individual spending is not. It's terrifically distorting, locking individuals into jobs they don't want and stifling entrepreneurship, burdening corporations with duties they shouldn't assume, and vastly increasing their power over employees. General Motors, after all, is a car company. They make cars. Who decided it should be in the health-care business, too? And if their employee decides to set off and make a better car, do we really want his plans foiled because he can't interrupt his daughter's dental care?

Rather than patching up the employer-based system and offering alternatives that individuals would maybe migrate toward, as both Clinton's and Obama's plans do, Wyden-Bennett end the employer-based system. They force employers to account for every dime and dollar they spend on employee health care and, the year after the bill's passage, redirect that cash into employee paychecks. So if your employer is spending $7,000 a year for your health insurance, your paycheck gets a $7,000 boost as soon as their bill passes. You have the money they spent on your health care, but you are no longer dependent on them for that health care.

Under the Wyden-Bennett system, health dollars would be controlled by the individual (a long-time conservative goal) and used within a restructured, heavily regulated, totally universal, insurance marketplace (a longtime liberal goal). Each state would create Health Help Agencies, who would provide easy access to insurance products, along with information, guidance, and advice on how to choose. Insurers would have to meet a minimum standard for comprehensiveness (equivalent to the standard Blue Cross/Blue Shield plan currently offered to members of Congress), and they could not discriminate based on pre-existing conditions, occupation, genetic information, gender or age. Nor could they deny insurance to those who ask for it. In return, every American would have to buy health insurance, and there would be hefty subsidies for those further down the income ladder.

The plan, to be sure, lacks some liberal priorities, notably a public insurance option. But it makes up for that by tightly integrating the system, going much further than Clinton or Obama do to bring the patchwork American health-care mess under one roof, where costs would prove more containable (the Lewin Group, a highly respected health-care consulting firm, estimates that the plan would save $1.4 trillion over 10 years) and future reforms and initiatives would be far easier. And they have done so along with 10 other senators. It's conceivable that, by the time the next president is elected, they will have created a legislative working group that can actually pass health reform -- something we've never had before.

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Ezra Klein is a Prospect staff writer.

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