"It's just very, very difficult," a frustrated Sen. Charles E. Grassley (R-Iowa) said after emerging from one meeting with fellow lawmakers last week.
Grassley, the senior Republican on the Senate Finance Committee, is a leading member of a bipartisan group that has been working for months on healthcare legislation with input from dozens of interest groups.
This is the seventh major push over the last century, and senior senators from both parties say they are trying to find common ground.
"I think we have been surprised at the amount of agreement there is," said Wyoming Sen. Michael B. Enzi, the senior Republican on the Senate Health, Education, Labor and Pensions Committee.
One thing lawmakers in both parties have agreed on is that people's existing healthcare arrangements should be disrupted as little as possible. In particular, people should be able to keep their insurance and their doctor if they want to.
"For lots of Americans, there won't be much change right away," said Drew Altman, an expert on healthcare politics and president of the nonprofit Henry J. Kaiser Family Foundation.
"That is inherent in the strategy."
Altman said that approach reflected the fact that most Americans report high satisfaction with their own care, even as they worry about rising costs.
In the same spirit, senior lawmakers and the administration are working to preserve the current employer-based system through which most Americans get insurance, while rejecting a single-payer system favored by some liberals, as well as a more free-market system favored by conservatives.
But signs of tension are already emerging, especially over provisions that Republicans charge would lead to government intrusion into the private relationships between patients and care providers.
Sensitive as those issues may be, many healthcare analysts worry that paying the bills may ultimately be where cooperation breaks down.
"The stars are aligned. The signs are promising," said Jacob Hacker, a political scientist at UC Berkeley who has studied previous efforts to overhaul the nation's healthcare system.
"But so far there has not been much congressional willingness to consider even relatively modest revenue-raising ideas," he said. "And in the healthcare debate, time is one of the greatest dangers. It gives people a chance to decide they are against whatever is on the table."
--
noam.levey@latimes.com
