A health care setup both sides could live with

Before long the Supreme Court is expected to rule on the health care reform law, a decision that will have tremendous policy ramifications and could reshape the presidential election.

But even if the court overturns the Affordable Care Act, as some observers predict, that won’t change the reality that our country’s health care system is seriously broken. In short, regardless of what the court says, people will still be getting sick, costs will keep rising and too many people will be uninsured. And our federal budget will never be sustainable if we can’t bring health care costs under control.

The Democratic Party and progressives invested a huge amount of political capital in getting Congress to pass the ACA in 2010. The act was not perfect, but it did provide a start to the many years of work needed to create a sustainable health care system. In speeches, Republicans and conservatives acknowledge that our health care system is unsustainable and have spoken of a need to “replace”; however, in the two years since the ACA passed, they have failed to be clear about what they actually favor.

As we look to what we’re actually going to do about the problem, what’s clear is that progressives and conservatives both need to move beyond their familiar positions to find a new kind of deal. This seems politically impossible before November, but politicians on both sides would do themselves – and the country – a big favor if they quietly started devising a solution that everyone can live with, even if neither side gets everything it wants.

For progressives, universal coverage has always been the Holy Grail and dream deferred, not just of health policy, but of all social policy. I don’t think conservatives have a health policy interest that is so clear and heartfelt as universal coverage is for progressives, but if I had to take a stab, I think it is their belief that people don’t have enough “skin in the game” and are therefore wasteful of other people’s money.

Each side holds its view with near religious fervor and thinks the other side’s position makes little sense.

Accepting such differences is vitally important, because reaching a deal will mean abiding with one another to reach a compromise. Once that is accomplished, the key first step of the deal (reform will require many steps) should do the following: Provide universal coverage for catastrophic health care costs that could truly wipe out a family, like suffering cancer or being in a car crash, but make the deductible so high – perhaps $10,000 for an individual and $15,000 for a family – it would protect against people taking financial advantage of the system.

It would be implemented through Medicare, a large risk pool that could keep the per-person cost of such coverage as low as possible. People could then purchase private insurance to cover the large deductible (no mandate), or employers could provide such gap insurance.

Recently, I was in a convenience store, and there was a jar on the counter seeking donations toward the $250,000 hospital bill of a young man injured in an accident. Under my proposal, you could still have such a jar, but the maximum amount it would be seeking would be $10,000.

Both sides are likely to respond to this idea with “yeah, buts”; still, it’s an approach that would give everyone the core of what they want.

A health reform compromise like this begins, first and foremost, by acknowledging and accommodating the “big idea” for both sides. It’s the essential first step for everyone to move forward.

Will we be able to have this debate immediately after the court issues its ruling? Probably not. First we’ll need to endure days or weeks of predictable rhetoric from politicians with predictable positions.

But the day after the ruling, and the day after that, people will still be getting sick and our system will still be broken. We ought to be thinking now about how we might actually start to fix the problem in a way both sides might live with after the November election.

Donald H. Taylor Jr. is associate professor of public policy at Duke University and author of “Balancing the Budget is a Progressive Priority,” published last month. He blogs at donaldhtaylorjr.com and www.samefacts.com.