In the latest issue of The Weekly Standard, Capretta and Levin offer a roadmap for a bipartisan bill. You should read the editorial in its entirety, but the three basic components are:

(1) Expand state-based high-risk pools to aid individuals with pre-existing conditions
(2) implement medical malpractice reform
(3) and free the states to find new ways to expand coverage

David Herszenhorn outlines the obstacles to a bipartisan bill, yet he identifies a number of possible compromises. As Hersezenhorn makes clear in an excellent and very thorough post, the Republican leadership in both chambers has resisted a variety of compromise measures. Yet individual members have advanced a number of interesting ideas, including the following:

Many Republicans abhor a provision in the Democrats’ legislation that requires virtually every American to obtain insurance or pay financial penalties for failing to do so — a so-called individual mandate.
Some Republicans, instead, have proposed a system of automatic enrollment by which any uninsured American seeking medical care would be entered into a computer system and, provided they qualify, signed up for a government-subsidized health plan.
Would Democrats go along if such automatic enrollment were not optional but mandatory for anyone seeking care who could not pay their doctor or hospital bill on the spot? What if it were coupled with incentives to get people to visit the doctor for an annual physical, or to enroll in a prevention and wellness program?

This strikes me as a very interesting concept, and it’s one that doesn’t have the flaws of the hilariously weak “mandate” proposed in the Senate health bill — an invitation to free-riding that would likely precipitate a so-called “insurance death spiral.”

Moreover, while the Republican leadership has resisted dedicating real resources to state-based high-risk pools, as Capretta and Levin recommend, Herszenhorn notes that are many Republican members who would be open to the idea, not least because, as Capretta and Levin put it, generous funding for risk pools — temporary funding is envisioned in the Senate and House health bills as a transitional step before the regulations are in place — would nevertheless be “nowhere near the scale of Obamacare’s costs.”

There are many other areas that seem ripe for compromise.

Interestingly, Jonathan Cohn points to Herszenhorn’s post as evidence that the GOP is the “Party of No.” But one wonders if it is equally correct to say that Democrats have become the “Party of Our-Way-or-the-Highway.” Ezra Klein has the same reaction, and he repeats the notion that the Senate and House health bills really represent a substantive compromise.

First, it asks retiring, knowledgeable conservatives about where the two parties could compromise. The reply? High-risk pools and selling insurance across state lines. It’s true that the two parties could compromise on those issues. In fact, they did, and the Senate bill includes versions of both policies. That compromise may or may not be good enough. In any case, neither policy matters very much. The Republican health-care bill included both ideas, and the CBO scored it as leaving 52 million Americans uninsured. As Herszenhorn says, it would “barely make a dent.”

This is an interesting characterization. The Senate bill does indeed allow interstate compacts, though of course these compacts are designed to minimize the opportunity that individuals have to free themselves of expensive state-based coverage mandates for various medical procedures. There is a reason for this — limiting adverse selection. But to say that the Senate bill includes a “version” of interstate competition that gives state governments the power to decide which states will be allowed to compete doesn’t exactly mesh with conventional understandings of competition. Let’s say we gave Halliburton the right to choose the other firms that will bid for large-scale energy contracts.

And it is also true that high-risk pools are included as a transitional measure before the Senate and House health bills ban risk adjustment, a ban that is greatly facilitated by a mandate. But of course the mandate is too weak to actually solve the adverse selection problem.

As a friend explained to me, the goal of the Democratic legislation is to create a universal structure that can be expanded over time. Very few knowledgeable people believe that the weak mandate in the Senate bill will work. Rather, it will lead to sharp increases in premiums that will create political pressure to further expand public programs.

So there you have it: the “Party of No” and the “Party of My-Way-or-the-Highway.” The “Party of No” framing is thus vitally important to those who advocate a centralized approach to controlling costs. A bipartisan bill along the lines that Capretta and Levin propose would likely prove popular and, provided it had the necessary resources behind it, it really would dramatically ease the burden on individuals with pre-existing conditions. It would thus forestall a centralized approach for a very long time.