I have been following the issue of health care reform for lo these many many months and watched the entire health care summit organized by the Obama administration. While it is apparent that little changed in the debate, the summit did clarify the differences between the two political parties. The major differences on extending coverage to 31 million of the 47 million uninsured, eliminating preexisting conditions exclusions by insurance companies, mandating coverage, reforming Medicare, and controlling costs remain irreconcilable. The administration is firmly committed to comprehensive reform and the Republicans are as firmly committed to scrapping the existing bills and starting over with a step-by-step approach.
For many there are some fundamental moral issues at stake that define who we are as a nation. Extending coverage to 31 million more Americans will begin the process of rationalizing our non-system and as detailed in the current Democratic proposal will reduce the numbers of people who die prematurely or who are forced to declare bankruptcy because of high health care costs. The Republican counter proposal extends coverage to 3 million over ten years while thousands are joining the uninsured pool daily, basically ignoring the problem.
The Democratic proposal prohibits insurance companies from denying people coverage because of preexisting conditions and mandates that people buy insurance. There is apparent agreement that preexisting condition exclusions should be eliminated but there is no agreement on how to accomplish that goal. The Republicans oppose the mandates and offer high risk pools for those affected by this insurance company policy. The obvious problem with that approach is that the insurance companies will be able to deny coverage to those who need it most and over the long term the cost of the high risk pools will continue to increase while the insurance companies enroll the healthy. In fact the Democratic plan does provide for short term high risk pools for the uninsured until the mandates become effective. The Democrats can’t win on this one. Obviously the most efficient way to address this problem is with a single payer system that taxes everyone as we do now for Medicare, but that approach never made it to the table because it is characterized as a big government socialist program. Now the mandate alternative, that would preserve the private insurance participation, is criticized because it requires people to buy insurance from private companies.
The Democrats are heavily criticized for the provision that begins the process of reforming Medicare. There is unanimous agreement that Medicare, in its current form, is unsustainable, and as Senator Coburn pointed out as much as a third of Medicare costs are not spent to treat illness. But here again, the Republicans have attacked the administration plan provision that reduces Medicare expenses by $500 billion over ten years including the $125 billion or so to reduce the taxpayer cost of the Medicare Advantage program.
The Republican proposal to control costs begins with reform of the tort system. While tort reform is important for reasons beyond just the cost, it is disingenuous to argue, as Congressman Boehner does, that it will result in huge cost savings. The best estimates of cost savings come to from 1% to 3%. This is an issue on which I think President Obama is open to compromise, but it’s clear that compromise will win no Republican votes while probably losing a few Democrats.
Reducing health care costs is the big elephant in the room and it is not adequately addressed in the current legislation. There are provisions for beginning a number of different pilot programs to determine those that might be effective. It is unclear how the inclusion of 31 million more Americans will impact the current cost shifting problems. Will emergency room cost be reduced? Will the diagnosis and treatment of diseases earlier reduce overall costs? Will more effective prevention services lead to a more efficient system? The optimistic part of me remains hopeful that many of the unintended consequences of beginning health care reform now will be positive.
There is no doubt in my mind that now is the time to act. Starting over with a step-by-step approach means maintaining the status quo, the consequences of which are not healthy for our nation and are easily predictable. Does anyone doubt that absent a beginning of reform our current non-system will become more irrational? WellPoint/Anthem has just announced a 25 to 39 percent premium increase in California for the self-insured and self-employed policy holders. The company reasoning is that because of the recession more of the healthy members are dropping coverage and therefore the premiums have to be increased because the remaining policy holders are more expensive to carry. Is this our future?
Doing nothing is not an acceptable option. It is time for the Democratic Party to honor the election of 2008 and pass health care reform now. There are worse things than losing a future election or ending a political career. The consequences of bankruptcy because of lack of access to health insurance are severe for individuals,families and communities. Allowing Americans to die because of lack of access to reasonable health care is immoral.
For many there are some fundamental moral issues at stake that define who we are as a nation. Extending coverage to 31 million more Americans will begin the process of rationalizing our non-system and as detailed in the current Democratic proposal will reduce the numbers of people who die prematurely or who are forced to declare bankruptcy because of high health care costs. The Republican counter proposal extends coverage to 3 million over ten years while thousands are joining the uninsured pool daily, basically ignoring the problem.
The Democratic proposal prohibits insurance companies from denying people coverage because of preexisting conditions and mandates that people buy insurance. There is apparent agreement that preexisting condition exclusions should be eliminated but there is no agreement on how to accomplish that goal. The Republicans oppose the mandates and offer high risk pools for those affected by this insurance company policy. The obvious problem with that approach is that the insurance companies will be able to deny coverage to those who need it most and over the long term the cost of the high risk pools will continue to increase while the insurance companies enroll the healthy. In fact the Democratic plan does provide for short term high risk pools for the uninsured until the mandates become effective. The Democrats can’t win on this one. Obviously the most efficient way to address this problem is with a single payer system that taxes everyone as we do now for Medicare, but that approach never made it to the table because it is characterized as a big government socialist program. Now the mandate alternative, that would preserve the private insurance participation, is criticized because it requires people to buy insurance from private companies.
The Democrats are heavily criticized for the provision that begins the process of reforming Medicare. There is unanimous agreement that Medicare, in its current form, is unsustainable, and as Senator Coburn pointed out as much as a third of Medicare costs are not spent to treat illness. But here again, the Republicans have attacked the administration plan provision that reduces Medicare expenses by $500 billion over ten years including the $125 billion or so to reduce the taxpayer cost of the Medicare Advantage program.
The Republican proposal to control costs begins with reform of the tort system. While tort reform is important for reasons beyond just the cost, it is disingenuous to argue, as Congressman Boehner does, that it will result in huge cost savings. The best estimates of cost savings come to from 1% to 3%. This is an issue on which I think President Obama is open to compromise, but it’s clear that compromise will win no Republican votes while probably losing a few Democrats.
Reducing health care costs is the big elephant in the room and it is not adequately addressed in the current legislation. There are provisions for beginning a number of different pilot programs to determine those that might be effective. It is unclear how the inclusion of 31 million more Americans will impact the current cost shifting problems. Will emergency room cost be reduced? Will the diagnosis and treatment of diseases earlier reduce overall costs? Will more effective prevention services lead to a more efficient system? The optimistic part of me remains hopeful that many of the unintended consequences of beginning health care reform now will be positive.
There is no doubt in my mind that now is the time to act. Starting over with a step-by-step approach means maintaining the status quo, the consequences of which are not healthy for our nation and are easily predictable. Does anyone doubt that absent a beginning of reform our current non-system will become more irrational? WellPoint/Anthem has just announced a 25 to 39 percent premium increase in California for the self-insured and self-employed policy holders. The company reasoning is that because of the recession more of the healthy members are dropping coverage and therefore the premiums have to be increased because the remaining policy holders are more expensive to carry. Is this our future?
Doing nothing is not an acceptable option. It is time for the Democratic Party to honor the election of 2008 and pass health care reform now. There are worse things than losing a future election or ending a political career. The consequences of bankruptcy because of lack of access to health insurance are severe for individuals,families and communities. Allowing Americans to die because of lack of access to reasonable health care is immoral.
Thank you for the thorough and thoughtful analysis which cuts through a lot of the wordy morass currently appearing in the papers and on news channels. I hope you sent it to Matheson although I doubt he will support anything not Republican sponsored. He and the guy from Idaho appear to have their feet set in concrete.
Posted by: Lorraine Furia | March 03, 2010 at 11:11 AM