Alternative to Bleak Reform Scenario: Stress Provider Changes

What is to be done? That is the question uppermost on Democrats' minds as they ponder the fate of healthcare reform in the wake of Republican Scott Brown's victory in the Massachusetts Senate race yesterday. So far, nobody has a really good idea. As a result, the possible death of reform is on the tip of some Democrats' tongues-and, of course, is what Republicans devoutly desire.

None of the obvious alternatives seems to be workable. The Democrats are not going to try to ram the legislation through before Brown is seated two weeks from now. Even if that were logistically possible, it would enrage many voters. It also seems unlikely that there are enough votes in the House to pass the bill that has already cleared the Senate-a maneuver that, if successful, would avoid a Senate filibuster when the reconciled version of the bill returned to that chamber. And while a stripped-down version of the measure could be attached to a "budget reconciliation" bill that would require only a simple majority to pass the Senate, so many key portions of the bill would have to be dropped that it would be a Pyrrhic victory.

On Huffington Post, Dylan Loewe makes a sensible suggestion: The House might be willing to swallow the current Senate version, he says, if its members were promised that the provisions they object to would be renegotiated in a follow-on bill. But it's still a long shot that enough House votes would be there for the current legislation, and there's no guarantee that the Senate would pass the later measure.

Meanwhile, Sen. Susan Collins of Maine-a relative moderate Republican-says that she's willing to work with Democrats to develop an alternative to the Senate bill. To judge by past Republican statements and proposals, that would not be very productive. The Republicans, after all, are hoping that healthcare will be President Obama's Waterloo, as South Carolina Rep. Jim DeMint indelicately put it. If the Democrats give up the ship on healthcare, the Republicans will let it sink.

Here's another idea. While it would not be popular with liberal Democrats, it might just attract enough Republicans like Collins to pass the Senate. Instead of trying to reform health insurance right now, let's focus on reforming the healthcare delivery system with an eye to containing costs. There are already some pretty good proposals on that score in both the House and Senate bills. Perhaps they should be combined into one measure that would focus with a laser-like intensity on the problem of runaway health spending. The Republicans and many voters say that that's their top concern: Let's take them at their word, and see what they do.

Of course, there is still bound to be pushback against the creation of a Medicare advisory council that would have broad powers to regulate provider reimbursement with only minimal Congressional oversight. But it's entirely possible that efforts to promote accountable care organizations, payment bundling, medical homes and other methods of restructuring the delivery system could gain bipartisan support. If some of these initiatives bore fruit and began to bend the cost curve, then a few years from now, we could try again to enact legislation to achieve universal coverage. By then, if health cost growth levels off, it might be more politically palatable to subsidize coverage for the uninsured, because insurance will be more affordable.