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Daschle, Dole team up for health care this time

Fifteen years ago, when Democratic Sen. Tom Daschle was running interference for the Clintons' effort at health care reform, his goal in life was to enlist Sen. Bob Dole, the hugely influential Republican leader, as a co-sponsor. Daschle never got him, and the enterprise crashed and burned.

When I did a joint interview with the two of them this week, Dole remarked that "we started out working together, and then it fell apart" - the victim of a massive lobbying campaign, a bunch of tactical errors by the president and first lady, and Dole's presidential ambitions, which moved him into the camp of the Republican naysayers.

Now, 15 years later, Daschle and Dole, along with another former Republican leader, Howard Baker, have come together with a report outlining the provisions of a possible bipartisan health bill - and strong recommendations on how to pass it. (The fourth original member of this Bipartisan Policy Center board, former Democratic leader George Mitchell, dropped out to become President Barack Obama's special envoy to the Middle East.)

In a phone conversation the day before their report was officially released, Daschle and Dole agreed that prospects for enactment of major reform are far better now than in 1994 - and better than they would have been even two years ago. "The situation is far more dire on costs and quality and access to care," Daschle said. Added Dole: "You have business, labor and a whole cross section of people saying, 'We have to have reform.'"

But it will still be a heavy lift. Like Obama, they estimate the added cost of insuring the 46 million without health coverage may total $1.2 trillion over 10 years, and say that at least half that will have to come from new revenues - if the Obama goal of budget neutrality is to be met.

To raise it, they would assess large companies that do not offer employees health insurance a fee based on their payrolls - a mandate that Dole acknowledges would be hard for many Republicans to swallow. And they would impose taxes for the first time on the so-called Cadillac policies paid for by employers - a change opposed by many Democrats, by unions and by Obama when it was advocated by John McCain during last year's election campaign.

But that is only the beginning of the bitter medicine Dole and Daschle are asking their fellow partisans to choke down.

Acknowledging that there is little chance for bipartisanship in the House, Dole urged Senate Republicans to give up any thought of filibustering the health bill. "We need a group of Republicans who will give an early demonstration that bipartisanship is possible," he said.

Daschle, in turn, said he thinks the Democrats should not attempt to ram a health bill through the Senate by using the budget reconciliation device to pass it with 51 votes, rather than the 60 votes most legislation requires.

Daschle, who would have been Obama's point man on health reform had his tax returns for recent years not caused him problems, made the point that a reform of this magnitude should not be forced through on a narrow majority. Australia, he said, "passed and repealed health reform several times before they got a strong enough vote to sustain it."

It is significant that the Daschle-Dole plan sidesteps the raging controversy over whether there should be a government-sponsored plan to compete with private insurers. Obama and most other Democrats are demanding it; Republicans and conservative Democrats call it a deal-breaker.

Daschle reluctantly agreed that there would be no federal government plan. Instead, individual states that wanted it could include such a plan on the menu for their residents, with technical help from the feds in setting it up. Five years from now, if a demand for such an option still exists, the president could recommend it - and Congress would have to vote on it.

It was hard for Dole and Daschle, neither of whom faces the voters or the lobbyists, to agree. It will be much harder to extract a bipartisan bill from Congress.

E-mail nationally syndicated columnist David Broder at davidbroder@washpost.com.