Under the name "health insurance purchasing cooperatives" (HIPCs), purchasing groups for health care consumers were a key feature of the Cooper-Breaux legislation that New Democrats supported during the 1994 health care debate -- legislation that Republicans shot down along with the Clinton Health Plan. Indeed, purchasing groups are central to all reform plans based on the "managed competition" model that so many Republicans demonized as socialized medicine during that toxic debate.

It's ironic, and important, that Republicans now seem to be discovering the virtues of health purchasing groups. House Commerce Committee Chairman Thomas Bliley (R-VA) is working on a proposal to create private sector "health marts" -- purchasing groups through which employers could buy their employees into a system that provides a broad range of choices of health insurance plans, modeled on the popular and cost-effective Federal Employee Health Benefit plan. The proposal would allow employers to apply the current tax break for employee health benefits for participation in "health marts," and would presumably help make health plans affordable for many small businesses that do not provide employee health insurance at all.

The impetus for this proposal is to make managed care plans more accountable to patients without increasing costs, thereby blunting the drive for government regulations to protect patients. This is a political imperative for many Congressional Republicans, who are caught between the rock of Democratic demands for a "Patients Bill of Rights" aimed at health plan abuses, and the hard place of Republican Rep. Charles Norwood's more draconian Patient Access to Responsible Care Act (PARCA).

Perhaps if they think about it long enough, Rep. Bliley and his GOP associates may realize that "health marts" are a good idea in themselves, worth pursuing whether or not they are politically useful. Who knows, they may even discover that if it makes sense to model a private "health mart" for employers on FEHBP, it also makes sense to provide access to FEHBP itself for Americans who do not have access to employer-sponsored plans, as has been recommended by Senator John Breaux (D-LA) and by the Progressive Policy Institute as a variation on the President's Medicare "buy-in" proposal. Finally, since only employers currently receive a tax break for buying health insurance, it's a small logical leap to envision a system where individuals would receive a tax credit for purchasing their own insurance through "health marts," public or private. Take the Bliley proposals and think it through logically and you arrive at the longstanding Progressive Policy Institute vision of an Information Age system -- a health "network" -- in which purchasing groups, health plans, and providers all compete to give people better health.

The bottom line is that purchasing groups, public or private, can create a true "buyer's market" for health insurance -- lowering costs, increasing choice, and immeasurably improving health care quality without over-regulation. If both Republicans and Democrats would move in that direction, the sterile health care debate of the last few years can finally come alive.