Healthcare reform tango

IT'S A daze of dueling policy prescriptions.

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On Wednesday, Senate President Robert Travaglini addressed the Greater Boston Chamber of Commerce, offering a broad outline of the Senate's approach to expanding healthcare coverage.

Just hours later, Governor Romney unveiled, after at least three previews, his own legislation to clear the way for lower-cost private health insurance.

Each camp is eyeing the other's timing suspiciously.

Romney's folks insist the governor had had his press conference and several related events on tap for days and, what's more, had told Travaglini on Monday that he would file his bill this week. And, further, that they had no idea the Senate president had similar plans.

Asked about the timing, Travaglini said his speech had also been planned ''for a while," something other sources confirm. ''I am not watching the actions of the administration or predicating my maneuvering on what they do," he said. ''I have no idea how this coincidence happened."

Certainly each side has reasons to want center stage.

Romney has just endured a stretch that would make the Keystone Kops look like competency consultants. Last week, the Legislature brushed aside the governor's concerns and passed a stem cell bill by margins that promise an override of a vowed Romney veto.

This week, the Globe revealed that Angelo Buonopane, the state director of labor, was treating his job as though it were a rotten borough. After several days of defensive fumbling, Romney's team pushed out the no-heavy-lifting hire.

On Tuesday, the day of Buonopane's demise, the administration declined to send anyone to testify on its own tax-loophole-closing legislation, a move that had even some administration members shaking their heads. One suspected reason: It had drawn the ire of Grover Norquist, the antitax activist influential in national Republican politics.

After a week like that, the governor needs to regain the initiative.

Travaglini is enjoying a much better run, but he too has scene-stealing motives. Having scored a reputation-enhancing win on his stem cell legislation last week, his team hopes to capitalize on it in a way that establishes the Senate president as the Beacon Hill agenda-setter.

But though this kind of jockeying may be inevitable, the two sides agree on some basic principles.

Neither, for example, wants new taxes, though financing of the $168 million Senate plan would initially require dipping into reserves, a questionable method of financing a fairly pricey proposal. Both would give the market more flexibility to lower health-insurance cost, though the Senate also has an eminently reasonable surcharge for companies of 50 or more whose employees use the free-care pool.

The governor's policy team has labored mightily to come up with a proposal it believes will reduce the effective cost of basic healthcare coverage to $134 to $160 a month for an individual and to as low as $350 a month for a family. The Senate has embraced a similar idea. But it would also do something Romney has yet to agree to: implement a significant increase in the rates the state pays to hospitals, doctors, and community health centers providing care under Medicaid.

Upping rates is important. By paying only about 80 cents on the dollar of Medicaid costs -- well below the national average of about 97 cents-- the state has put pressure on everyone's healthcare costs, since hospitals make up some of the difference by charging insured patients more. The low reimbursement rates have also pinched the healthcare sector, a key driver of the state's economy.

With the revenue picture improving, that squeeze is increasingly problematic policy, particularly at a time when the administration is pushing a tax cut.

When I asked Romney about increasing Medicaid rates on Wednesday, he essentially brushed the question off, saying Health and Human Service Secretary Ron Preston would review the issue.

Preston took refuge in an almost impenetrable thicket of verbiage, the upshot of which seemed to be that he will consider the matter with a frame of mind somehow both receptive to and skeptical toward the state's major healthcare providers.

There's room for compromise here. But it will happen only if both parties put away the egos and elbows -- and resolve that on this one, what gets done is every bit as important as who gets the credit.

Scot Lehigh's e-mail address is lehigh@globe.com.