×
Igor Volsky takes some shots at the president of the NFIB for saying that it's hard to say where they'll compromise before there's anything specific on the table, but that's actually a perfectly sensible position. Volsky, of course, knows what comes to his mind when he hears the word "compromise" because he, like most political observers, knows where the fights will be: The employer tax deduction, the public option, and the employer mandate.But even as everyone girds for those wars, you hope that both sides have smart strategists thinking about how to push the envelope on the areas where there is initial agreement. For instance, the letter the Republican leadership sent to Obama got headlines for opposing a public insurance option and assailing the reconciliation process. But it also said:
Any serious health care reform proposal cannot be solely about expanding coverage, but must also include innovative strategies to change the health care delivery system to reduce costs and encourage better value. We must strengthen health care by realigning incentives to provide consistent, dependable quality while promoting the principles of care coordination and prevention.The devil is in the details on that, but if you could muster bipartisan agreement on radical delivery system reforms, you could do a lot of good. Neither side would necessarily raise their hands in victory over new payment incentives or the expansion of the medical home model, but the system would be in far better shape. Indeed, really good delivery system reform would do a lot more to ensure affordability and continuous care for low income Americans than slightly more in coverage subsidies. But the fights over subsidies will be loud and the meetings on delivery reform quiet. Hopefully, however, they'll happen, and receive real attention. The danger is that everyone's focus is drawn to the points of conflict and relatively little energy is directed towards maximizing policy progress in the areas where there's a rough consensus.
