The public shares in real progress on U.S. health care form

PROGRESS in Congress on national health-care reform is extraordinary. The completed House bill and the Senate version taking shape differ in key areas, but the points of contention are defined and understood.

Reconciliation and compromise are the essence of doing business on Capitol Hill. The way forward is about the gritty details, and well beyond the early, emotional debates.

Public demand for competition in the insurance industry kept alive the idea of a government-run option available to qualifying individuals as a choice for coverage through insurance exchanges.

Sen. Maria Cantwell champions a variation on that theme that gives states the resources and negotiating power to bargain the best coverage for those least able to afford insurance in the individual market. States would bargain for the best price with the new federal option and private carriers.

The House and Senate share a significant indicator of the new legislative attitude about reform. Both chambers want to strip the insurance business of its antitrust protection — a good, fundamental move.

Rep. Jay Inslee is working to give Washington health-care providers equity in Medicare reimbursement rates. Providing effective, efficient medical care has actually hurt providers financially in a system that does reward or promote high-value health care.

Inslee and others worked to include language in the House bill that will study Medicare reimbursement rates and reward best practices.

Both the House and Senate will require mandatory insurance coverage, though they disagree at the moment on the financial penalties to enforce participation. A broad, deep insurance pool, mixing ages and health status, keeps costs down and spreads the financial risk.

For all the rhetoric, the House and Senate have core agreements on reform. Strong public sentiment for change shares in the credit for the progress.