Old foes finally talking on health care reform

While most of the nation was absorbed in the latest twists in the economic crisis last week, a remarkable group of individuals and organizations were shoving their chairs toward the negotiating table for a new look at health care reform.

The complexity of the problem and the many powerful interests at stake argue against hope of any real success. However, the urgency articulated by all parties, including grizzled antagonists of change, suggest that new and transformative opportunities may be within reach.

Tom Daschle, the former Senate Democratic leader, was chosen by President-elect Barack Obama to be the point man for reform as secretary of health and human services. A passionate advocate for a health system overhaul, Daschle authored a book this year calling for a bold merger of private insurance, Medicare and Medicaid, with an expansion of the federal employee benefits program.

The Daschle announcement was followed by Congressman Henry Waxman's seizing control of the House Energy and Commerce Committee. The wily Californian has pressed for progressive health measures, including expanded coverage for low-income children, and could be a valuable ally to Daschle and Obama.

Across the table, health insurance companies signaled their willingness to compromise. The industry played a key role in batting down the last reform plan under President Bill Clinton. Insurance companies say they would support new regulations requiring them to provide coverage for people with pre-existing illnesses if such guarantees were paired with government mandates on individuals to purchase insurance.

The conditions laid out by the industry are self-evidently self-serving, but they also represent a growing consensus that government must assume a larger role in the health care system, a realization also articulated by automakers, Wal-Mart and other businesses.

More particularly, reform advocates and many businesses share a common belief that rules requiring everyone to purchase insurance are essential. The controversial concept was noticeably absent from the health care plans of both Obama and Republican candidate John McCain.

Expanding government-operated insurance pools could be prohibitively expensive, absent mandated universal coverage to help keep premiums low. But penalizing individuals without insurance through fines or taxes will be a tough sell for the American public. That's just one of many complicated questions facing the men and women preparing for months of negotiations, but its resolution is essential to any final agreement.

The nation's health care system has needed a cure for many years, but its problems have metastasized to the point that there is now broad recognition that strong medicine is needed. It's just a starting point, but it's a promising one.