Democrats saddle up for health care: Will they ride a camel or a horse?

A camel, the old saying goes, is a horse made by committee. We don't want camel health reform. We don't want Washington lawmakers debating whether it should have one hump or two. We want a horse — a sleek machine that performs with efficiency.

One may prefer that landmark legislation enjoy wide bipartisan support. That's the ideal. But the health-care system has too many moving parts to allow for much ideological tinkering, particularly by those who are not wild about reform to begin with. Better that Democrats go it alone than help create an ungainly beast in the name of compromise.

The Medicare drug benefit was a camel of a program. It mated a liberal proposition — expanding a government entitlement — with a conservative solution — having private insurers dispense the coverage and forbidding the government to negotiate drug prices. The result was a complicated benefit that cost taxpayers a lot more than it had to.

Democrats are now firmly in charge and can push through legislation without a single Republican vote (and even the loss of a few conservative Democrats). All they have to do is use the budget reconciliation process, which lets a bill pass the Senate with a simple majority vote.

Thus, Democrats have the freedom to design an effective program that reaches two essential goals. One is to bring coverage to everyone. The other is to contain spiraling health-care costs while maintaining quality of care. The second goal is much harder to meet than the first. You can't cut medical spending without stepping on a lot of economic interests happy with the way things are.

Controlling costs hinges in large part on a proposal that Republicans and the insurance industry detest. This is the public option, a government-run plan that would compete with the private insurers.

Critics call it a deal-killer. The insurance companies complain that a government alternative would stack the deck against them. Its supporters hold that the public plan would keep the private ones honest.

In hopes of winning over some public-plan skeptics, Sen. Charles Schumer, a New York Democrat, has proposed to level the playing field by forcing any government-run plan to abide by the rules applicable to private insurers. The government would also have to reimburse doctors and hospitals at higher rates than does Medicare, so there's no beating down of providers on price.

This offer has not appeased the insurance-industry trade group, America's Health Insurance Plans. Its members clearly don't want to compete against an entity that doesn't have to spend billions enriching executives and marketing its wares.

If the private insurers can work some magic that produces a better product at comparable cost, then more power to them. But if a public plan takes their business because it delivers fine health care for less money, what's wrong with that? Private insurers can still cover what the government plan does not.

About the politics: In 1993, President Clinton's health-care reform went down in flames — and in 1994, Republicans tromped Democrats and took over Congress. Had Americans rejected the Clinton plan, or were they taken in by the smear campaign against it? Was it something else?

Whatever happened then, now is different. Health-care insecurity sweeps the land. American businesses are panicked by their rising employee-insurance premiums. And in this era of Wall Street bailouts, Republicans' "free-market solutions" don't have the punch they once had.

Democrats are in the saddle. They can push through a careful, rational design for health care and should do so. Some compromise may be necessary, but when the gun finally goes off, the creature out the gate should be a horse and not a camel.

Providence Journal columnist Froma Harrop's column appears regularly on editorial pages of The Times. Her e-mail address is fharrop@projo.com