And then there were two. The remaining health overhaul plans--the one that survived a near-death experience in the U.S. Senate on Saturday night, and the one that passed the House of Representatives three weeks earlier--both have flaws¡K.most notably, neither goes far enough to control costs.
Even so, they are far from the threat to humanity that Republican critics are trying to portray them as. In fact, both represent good-faith efforts to overhaul the national disgrace known as the American health care system.
Under the unacceptable status quo, if you lose your job, often you lose your affordable health coverage. If you have a pre-existing medical condition, you can¡¦t get insurance at any price, and, if you hate your job, you might stick with it just to keep your insurance. Even with these gaps, health care costs are rising at a rate that all sides agree is unsustainable.
If the non-partisan Congressional Budget Office is even close to being right, the Senate version in particular comes closest toward balancing the twin, if conflicting, goals of expanding coverage and restraining costs:
„P Coverage. The CBO estimates that 31 million people would gain insurance through this version. At the risk of stating the obvious, that¡¦s a big number. If it were a state it would rank second, behind California and ahead of Texas.
The Senate measure, like that in the House, would provide an alternative way, through new insurance exchanges, to get group health insurance for people who don¡¦t get it through their employer. It is hard to overstate how important this is. It would protect families¡¦ health and financial well-being, both of which are severely stressed and likely to stay so.
In good times and bad, the United States economy creates and destroys jobs. Whole industries can contract severely due to technological change, overseas competition or the mere fact that they had grown too big too fast. This plan would provide a more stable insurance backdrop to a turbulent economy.
The Senate measure does, however, have a flaw in this regard. Its mandate that people buy insurance is overly timid. It would allow them to opt out for a fee starting at just $95 a year in 2014 and then rising to $750 by 2016.
The mandate is vital to make the system work. In return, insurance companies would be required to sell insurance regardless of previous medical condition. Without a meaningful individual mandate, healthy people would wait until they got sick to buy insurance--and premiums would soar.
„P Cost. Obviously, the ranks of the uninsured can¡¦t be reduced for free. Overall, the Senate bill would raise spending by $356 billion and increase revenue by $486 billion between 2010 and 2019, reducing federal borrowing by $130 billion over the decade.
To put the numbers in perspective, the government is projected to spend almost $13 trillion over the decade on health care as is. Let¡¦s repeat that. If Congress does nothing at all, taxpayers will be called upon to spend some $13 billion. That¡¦s about $80,000 for everyone who files a tax return.
The Senate plan¡¦s claim to some minor savings is not convincing.
Most of the savings would come in the first five years. It relies on gimmicks such as pushing some reforms off until 2014, and it counts on Congress having the will to make necessary, but politically improbable, cuts in Medicare programs.
The Republicans, unfortunately, are offering worse. They¡¦ve hypocritically recast themselves as defenders of Medicare--socialized medicine that they love to attack.
The deficit?
Forget about it.
They claim the Democrats¡¦ bill would break the bank. Clearly, the bank is going to break anyway without much more dramatic action.
Democratic measures designed to cut health care costs--through such things as preventive care, digitized records, and changing the way doctors and hospitals are compensated--need to be strengthened. Republican ideas, such as malpractice reform, should be added. Even so, all those devices will still leave the tough decisions for a more responsible political era.
Arguably, it might have been better to blow up the current system and start over, but the Democrats¡¦ 1994 failure with health reform, combined with the tepid response to some more sweeping ideas put forward in recent years by conservatives and liberals alike, has assured that an approach like the current one is all that¡¦s politically viable.
This weekend¡¦s party-line vote to proceed with Senate debate allows the process to continue.
As the action moves to the floor after Thanksgiving, this plan will be called ¡§big government¡¨ and worse. If its cost control elements turn out to be credible, however, it is a reasonably good start down the road of fixing a broken health care system.
