Reconciling the House and Senate bills

Improvements on cost reforms and speeding up implementation makes a great deal of political and practical sense to me.

House Speaker Nancy Pelosi and her colleagues are clearly in a tough spot. They already seem poised to yield on abortion and the public option to get a bill through the Senate. Now the Senate and the White House will be asking them to be more serious about holding down costs, too.

But the health experts I spoke to this week thought there was room for a sensible compromise. The House’s liberal leaders have a few realistic demands to make in exchange for accepting the cost-control measures in the Senate bill. Ideally, the House would also accept a couple of additional measures being pushed by John Rockefeller, Ron Wyden and other Senate Democrats.

After all, as Mr. Rockefeller and Mr. Wyden have shown, there is nothing that says liberals need to be in favor of high medical costs.

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For starters, they can hold firm to their start date for the main provisions of the bill: Jan. 1, 2013, a year earlier than in the Senate bill. That would help the uninsured. It would also help deflate the argument that health reform is going to ruin health care — just as the start of Medicare, one year after its passage in 1965, beat back the argument that it equaled socialism.

Two, the House can push for a national insurance exchange, rather than the 50 different state exchanges envisioned by the Senate. State-by-state experimentation has its place, and giving the states no say over the exchange would be a mistake. But 50 exchanges, with 50 Web sites and 50 sets of rules, seems like a recipe for duplication and waste.

Finally, if House leaders are tired of watching senators preen as fiscal conservatives (and are tired of being called profligate by pundits), the House can call out the Senate on its own weakness. The Senate, like the White House, has been somewhat deferential to hospitals, drug makers and doctors’ groups. What if the House pushed for bigger discounts on prescription drugs, as its bill calls for — saving the government $10 billion a year in the process? Or what if the House insisted on bigger penalties for hospitals that don’t do enough to prevent hospital-borne infections?

Speeding up implementation would raise the price tag, but offsetting that with stronger cost controls could help to frame this as real reform and real benefits for the American people.