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REHABILITATING HEALTHCARE

After Brown's victory -- now what?

Reform is needed. Democrats should not let the GOP victory in Massachusetts derail it.

January 21, 2010

Republican Scott Brown's victory in the race to succeed the late Democratic Sen. Edward M. Kennedy of Massachusetts throws a sudden roadblock in front of President Obama's legislative agenda, ending the filibuster-proof coalition that the 58 Senate Democrats had assembled with two independents. It's also a rebuke to the majority party's pursuit of an array of ambitious initiatives at a time when the public is focused on one thing only: the stumbling economy. The most vulnerable of those initiatives is healthcare reform, which skittish Democrats may be tempted to abandon in the face of mounting public skepticism. That would be a mistake.

It's rare for either party to have the kind of power that Democrats enjoyed for the better part of last year, so Brown's arrival as the 41st Republican senator actually means a return to the regular order of business. Besides, the Senate Democrats' coalition was so fragile, it couldn't pass any major initiatives without at least a few Republican votes -- witness the bipartisan negotiations over new regulations on the financial industry and a cap-and-trade system for greenhouse gases. The big exception was healthcare reform, which Majority Leader Harry Reid (D-Nev.) muscled through the Senate last month with no Republican support.

Democrats don't have that kind of strength now, which creates a dilemma for them. Reid paid a heavy price to garner 60 votes, agreeing to carve-outs and grants for special projects to win the backing of a handful of reluctant Democrats and independents. The changes made the bill a tougher sell, not just to the House but also to an increasingly skeptical public. A compromise between House and Senate Democrats is within reach, yet there's little indication that any Republicans in the Senate will support it. Instead, the official Republican stance is that comprehensive reform is not just unnecessary, it's a toxic and illegal government takeover of the world's best healthcare system.

The unfortunate reality is that the U.S. system, for all its wonder drugs and surgical miracles, doesn't come close to matching the results and efficiency of its counterparts in other industrialized nations. And its steadily rising costs are on course to render Medicare insolvent within the decade, in addition to leaving millions more Americans unable to afford insurance, sending thousands of sick people into bankruptcy each year and slowing economic growth. Addressing those issues requires fundamental changes in how healthcare is delivered and paid for, replacing the current system's incentives to deliver as much treatment as possible with incentives that promote prevention and wellness. And unless the uninsured are covered, they'll be left out of this new, more effective and efficient system, and their costs will continue to be shifted onto the backs of those with insurance.

The competing bills passed in the House and Senate get the basic framework right. Their shortcomings are in the details, including how to pay for insuring the working poor and how to make sure that the promised cost savings materialize. The Senate bill also is pocked with provisions singling out states or individuals for unequal treatment. Although only some of these failings were being fixed by Democratic leaders as they negotiated a final version with the White House, the legislation seemed headed in the right direction.

The public, however, has grown more antagonistic toward the healthcare reform effort as the months have passed. Polls show that people are increasingly doubtful that Washington is going to make the current system better. The legislation has become a lightning rod for the anxiety stirred up by the recession, lingering joblessness and the debt that Washington amassed in responding to the economy's collapse.

Brown's stunning victory in Massachusetts will only strengthen lawmakers' impulse to view healthcare reform as an albatross around Democrats' necks, not a problem to solve. The right response, however, is not to abandon the measure, but to strengthen its provisions to slow the growth of healthcare costs and to provide more flexibility for consumers to obtain less-expensive coverage. Supporters of the bill should also hit the campaign trail and explain how its provisions would work to restrain costs, improve quality and protect consumers against cherry-picking by insurers. Such moves would make clear to those who already have insurance -- which is most Americans -- that they have something to gain from the measure too.

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