Health Care Reform

June 21, 2009 at 12:39 am Leave a comment

Health care reform in the U.S. got a rude wake-up call recently. The Congressional Budget Office (CBO) looked at a draft of the first substantial health care reform proposal since Obama became president—the Senate’s Kennedy/Dodd proposal—and announced that it would increase the national debt by $1 trillion dollars during its first decade, while covering only nine million more Americans. About 37 million people would remain uninsured.

Health care reformAs supporters of that bill will point out, it was just a draft.  If it were a baseball game, health care reform would be in the first inning.  But the truly eye-awakening reality check that followed was the discovery by the chattering, blogging, and twittering classes of another proposal, one that been in the works for three years, one that provides universal health care in the U.S. while producing, according to the CBO, an annual budgetary surplus starting in 2014.  One that ensures that Medicaid, Medicare, and private health insurance offer benefits that are at least as good as those that U.S. senators and representatives get today.

It’s called the Healthy Americans Act (HAA), and it already has the support of more than a dozen U.S. Senators from both parties.  Senator Ron Wyden (D-OR) has been working on this bill since 2007, with Senator Bob Bennett (R-UT) as the other sponsor, and co-sponsors that include Lindsey Graham (R-SC), Joe Lieberman (I-CT), Arlen Specter (R/D-PA), Bill Nelson (D-FL), and Lamar Alexander (R-TN).

Assuming you agree that our current system is financially unsustainable and a threat to U.S. quality of life and competitiveness, and you don’t approach the subject with any sacred cows in your barn (We must have single-payer!  Only the free market can solve this problem!), reading the details of HAA might make you wonder if the bill is too good to be true.  Here are some highlights:

  • Employees happy with their current coverage don’t have to change
  • All plans offer the same (or more) benefits that Congress gets from their health insurance
  • Portability across jobs (unless an employee chooses an employer-supplied plan)
  • Private health insurance providers cannot deny coverage to those with pre-existing conditions
  • Doctors get paid for time spent on chronic disease management and prevention.
  • States provide Consumer Reports-like analysis of the options available to its residents

The biggest change for those happy with their current employer-supplied coverage is that the current system of how that coverage is paid for changes.  The money the company is spending on your health care plan is given to you.  You can then keep the status quo and buy the coverage you already get, or you shop around, using information gathered by the state to help you choose.  You are required to buy coverage somewhere, but if the coverage your employer gives you is not what you want, you can go with an alternative.

Of course there are catches.  Employers, who usually change insurance options each year, could instead choose to just give you the money and make you go on the open market for insurance.  And those employees and union members who get top-of-the-line coverage, with little or no deductible or out-of-pocket expense, will also lose something.  Once the whole system transitions to the HAA one, really expensive plans will cost more than they do today.  That might be unfair in some cases: if you were a union member and gave away some pay increase in favor of that kind of health plan, you’ll be pissed off.  But one of the keys to containing costs is through HAA’s system of making us all aware of the cost of our health care choices.

And like the switch to digital TV, the anticipated pluses identified by the CBO (and private groups like the Lewin Group who have also reviewed HAA) probably have failed to find some other issues with HAA.  The analogy to the digital TV may be particularly apt, since that conversion showed that even after all the warnings and converter box subsidies, there were still millions who didn’t take advantage of the “preventative” services available to them.

So there will probably be a devil we don’t know. But the devil we do know is the current, unsustainable system.  At least the Healthy Americans Act has had more than two years of analysis behind it, and its politically viable.  Even if HAA in its present form isn’t adopted, it sets a standard against which all other options should be judged against.


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