Health care: Deal or no deal? Senators begin work

WASHINGTON (AP) — This time it’s really going to happen. Or so they claim.

Senators get down to work this coming week on turning ideas into legislation to cover some 50 million people without health insurance and contain costs for everyone else. Hopes are high that Democrats and Republicans can find common ground for a bill to emerge by summer.

They will have to defy history.

Grand plans to revamp health care have a half-century history of collapsing. More focused proposals, such as the creation of Medicare in 1965, have succeeded.

Lawmakers are far apart on some of the most important issues today, from the reach of government to the responsibilities of employers and individuals. And guaranteeing coverage for all could cost $1.5 trillion over 10 years, an eye-popping sum in a time of recession and mounting national debt.

Yet major constituencies often at odds are now clamoring for change. They range from consumer groups to insurers, from employers to doctors and hospitals. President Barack Obama has pledged to chip away at hardened ideological positions to find compromises.

“This is the toughest issue we have ever taken on — every part has got a chance of blowing up,” said Iowa Sen. Charles Grassley. He is the top Republican on the Senate Finance Committee, which oversees government health programs and taxes, and plans to start work Tuesday.

Grassley said he is reasonably confident that he and the chairman, Sen. Max Baucus, D-Mont., can produce a bill that appeals to the middle. “Our only hope is if we do it in a way that keeps the vast majority of both parties going in the same direction,” Grassley said.

Sen. Ron Wyden, D-Ore., sees opportunity. “There is a very appealing philosophical truce within the Senate’s grasp,” he said.

“Democrats are right on the idea that we’ve got to cover everybody. Republicans have been right on the role of the private sector, not freezing innovation and staying away from price controls,” Wyden said. “You meld those philosophical views and you are on your way to 68 to 70 votes.”

Consensus is growing on many points: Changes should build on the current system, not scrap it; hospitals and doctors should be paid for quality, not quantity; insurers shouldn’t be able to discriminate against people with health problems; small businesses need special attention.

Democratic leaders want the full House and Senate each to pass legislation before Congress leaves town for its August break.

Democrats probably will allow the use of a legislative device that would let them pass a health bill in the Senate with 51 votes, instead of the 60 needed to defeat a filibuster. Republicans say that would be an act of bad faith and could poison chances for a deal.