After President Clinton's health plan crashed and burned in 1994, conventional wisdom flipped. Pundits who had agreed that health reform should be "comprehensive" declared that progress could happen only incrementally - tackling a few problems at a time and building bipartisan consensus.
So they cheered when a liberal Democrat, Sen. Edward Kennedy, teamed up with a moderate Republican, Sen. Nancy Kassebaum, to introduce modest health reforms.Kennedy-Kassebaum, as this legislation is called, would require insurance companies to accept applicants regardless of pre-existing medical conditions and to allow employees to buy job-to-job health coverage. With different versions passing overwhelmingly in both houses, the bill was to be the perfect example of how well the incremental approach worked.
Alas, progress toward a unified bill that the president can sign has stalled. Gridlock, it turns out, can stop incremental as well as comprehensive health reform. How can this be?
One reason resides with Congress itself. Bills popular enough to quickly move ahead are rare, and when they do come along, lawmakers and lobbyists pile on amendments, even if this means slowing things to a crawl.
Urged on by the psychiatric lobby, for example, liberals and some moderates amended the Senate version of Kennedy-Kassebaum so that coverage for mental health would be on a par with that for physical illnesses. This reduced business and Republican support.
Incrementalism, in short, is no easy solution. It can go one way or the other - toward covering more Americans or toward unfettered individualism.
Everything depends on what is wedged into the final bill.