HOW THEY DISAGREED

February 26, 2010 at 12:00a.m.

Among the areas where Democrats and Republicans groped for accord at Thursday’s health-care summit:

OVERHAULING THE SYSTEM

Democrats are supporting massive legislation enacting a top-to-bottom overhaul of the system and requiring nearly everyone to be insured. Republicans say that approach needs to be scrapped and they want a step-by-step approach. If there’s somewhere to meet in the middle lawmakers haven’t found it yet.

PURCHASING POOLS

The Democratic bills establish state or national purchasing exchanges where individuals and small businesses in need of insurance could pool together and compare federally regulated plans. Sen. Mike Enzi, R-Wyo., said he liked the idea of the purchasing exchanges. But Enzi said any and all private insurance plans should be offered — not just those meeting federally established standards. Democrats say consumers need the protection of government-set standards.

COVERAGE FOR PEOPLE WITH HEALTH CONDITIONS

Democrats say the only way to accomplish those reforms is through a mandate for nearly everyone to carry insurance, which would create a large risk pool including many healthy people, enabling insurers to take all comers. Republicans oppose the mandate, and instead would set up “high-risk pools” where people with high-cost conditions could buy care. Democrats contend that as proposed by the GOP the pools would be so underfunded they’d be ineffective.

Source: Associated Press

—MEDICAL MALPRACTICE

This is a long-running dispute between Democrats and Republicans that Obama has cited as an area of potential compromise. The Republicans’ preferred solution is capping non-economic jury awards and Sen. John McCain, R-Ariz., argued in favor of that approach. But Democrats and their trial lawyer allies have rejected that notion repeatedly. Obama has announced the establishment of state-level pilot programs that Republicans say don’t go far enough. “I don’t think we have to experiment around,” McCain said.

Sen. Dick Durbin, D-Ill., countered that there should be no limits on payments to people injured in medical errors.

—PROTECTING SENIORS

Who could disagree with that? But Democrats and Republicans are far apart on how to do it. The Democrats’ legislation cuts hundreds of billions of dollars from Medicare, mostly from private plans within the system. Democrats would use some of the savings to close a coverage gap in Medicare’s prescription drug program and say their cuts would strengthen Medicare by extending the program’s solvency and eliminating inefficiencies and overpayments to private insurers. Republicans rail against the cuts.

Ryan has a different approach: He would give future Medicare beneficiaries vouchers to shop in the private market, something Democrats say would leave seniors out in the cold.

—KEEPING CHILDREN ON THEIR PARENTS’ HEALTH PLANS LONGER

This might be one of the few areas where Democrats and Republicans truly do agree — getting health insurers to offer family plans where children can stay covered by their parents until age 25 or 26. Laws vary by state, but typically children can stay on their parents’ plan through college. Allowing them to stay on some years longer wouldn’t cost the government. Insurers don’t object because people in that age range have low medical costs, and for that same reason costs to consumers wouldn’t go up too much.