Unresolved issues
Among the issues to be decided as more concrete proposals emerge in the months ahead is whether the roughly 46 million uninsured people in the U.S. will be pushed to buy private coverage or will be enrolled in a government insurance program, as some consumer groups want.
Hospitals and doctors fear another public program would reduce what they are paid, as Medicare and Medicaid have done. Insurers worry they could lose customers to the government.
Also unresolved is what mechanisms might be created to force individuals or businesses to get insurance, both potentially contentious subjects.
And few have tackled how the government will control costs and set standards of care, proposals that raise the unpopular prospect of federal regulators dictating which doctors Americans can see and what drugs they can take.
"There are some very big questions and some very big stumbling blocks," said Stuart Butler, vice president for domestic policy at the conservative Heritage Foundation, who has been watching the healthcare debate for three decades.
"Once you get into the details, the consensus is going to vanish pretty quickly, I suspect," he said.
At the same time, advocates for a single-payer system, including the California Nurses Assn., have vowed to continue pushing the idea next year along with many Democrats on Capitol Hill.
Republican lawmakers, still reeling from their election day losses, have signaled discomfort with a major expansion of government spending, a position many in the GOP hope will help return the party to power.
"Increasing access for the uninsured is not going to come cheap," Sen. Charles E. Grassley (R-Iowa) said at a recent hearing on healthcare reform. "And it's clear to me that our economy cannot stand much further deficit spending."
Nonetheless, the current agreement on principles contrasts markedly with previous reform efforts. Today, many of the key players in the debate see the importance of preserving elements of the current healthcare system that many Americans say they like.
"There is a growing understanding that you have to give people choice and you can't take away what they have," said Ron Pollack, head of Families USA, an influential advocacy group for healthcare consumers that is working with a diverse collection of interest groups to build consensus. "One of the big no-nos is that you must not ever threaten the coverage that people have."
