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RALEIGH — Crafting a federal health care reform compromise can seem especially daunting when two people invested in the issue don’t agree on the words used in the debate, much less on the debate itself.

Take North Carolina’s two U.S. senators. Republican Richard Burr and Democrat Kay Hagan both have said they would favor health care co-ops. These membership-based programs have been pitched as a way to cover more people while keeping costs down.

“Having been a state senator for 10 years, I think the states can do a good job at that,” Hagan said about the cooperative idea. Under one co-op scheme that’s been talked about, states would be responsible for organizing a nonprofit health care option, helped along by federal rules and perhaps some funding.

Burr said he, too, thought co-ops were an option, but only if federal and state governments don’t have much to do with running them.

“If the government is going to be in charge of it, and the government’s going to run it and the government’s going to decide the scope of benefits...then I’m not interested in going there,” Burr said.

Rather, Burr said, the federal government needs to create incentives for nonprofits and others to create co-ops by removing obstacles to their creation .

Both Burr and Hagan have been meeting with groups across the state during Congress’ monthlong August recess. Although it is not uncommon for lawmakers to use this time to visit with constituents, this year’s laser-focus on health care reform is unusual.

There are both Senate and House drafts of health care bills actively working their way through committees, as well as bills filed and drafted by others around Congress.

Burr, for example, is the co-author of a bill that focuses on making health care more “portable.” It would allow people to keep the same insurance company throughout their lifetimes if they wanted.

That, he said, would give insurance companies an incentive to keep people healthy and provide good customer service. What Burr’s bill doesn’t do it create any sort of new federally run health care program.

“I differ from the president on one big issue. I don’t believe it requires the federal government to be more involved in health care to create competition,” Burr said.

Democrats like President Barack Obama have said a public option of some kind is needed to keep insurance companies honest. Hagan has said she believes some kind of publicly managed program is necessary to provide a backstop for those who are not able to afford private coverage but who don’t qualify for public aid.

“It is an alternative to private health insurance,” Hagan said, adding, “Whatever that plan is, it’s got to meet the same requirements private companies have to do...To me, the key is, we’ve got to bring down the cost of health care.”

North Carolina’s senators are also taking a different approach to the legislation now before Congress. Hagan talks like someone who believes a health reform bill can pass before the end of the year and said the input she got over the break would be useful.

“There’s a lot of interesting things that people have shared with me, whether its a private physician, whether it’s a practice, whether it’s the hospitals, whether it’s the businesses — on certain components, each one has something different that they’ve seen in the bill that they want to discuss,” Hagan said. “Yes, I think that some of those items I am looking at very closely.”

Burr, however, says the discussion should be moved back several steps. Reserving most of his ire for the House version of the bill, HR 3200, Burr said there are too many unknowns to move ahead with the legislation as it is currently drafted.

“Providers and average citizens have pointed to things in 3200 that I didn’t even catch, that they see as negative impacts on their quality of care,” Burr said. “I think there’s got to be a lot more clarity than is in the legislation that’s on the table.”

Contact Mark Binker at (919) 832-5549 or mark.binker@news-record.com.