Democrats Prepare for Healthcare Reform Debate
How to pay for reform is the hot topic as healthcare bills move through Congress
It began with a leak two weeks ago, a chunk of a bill circulating in Washington that offered the first real glimpse of a Democratic plan for healthcare reform. By early last week, the leak had given way to the real thing: a 615-page draft put out by Sen. Ted Kennedy, the ailing liberal from Massachusetts, and accompanied by the outline of a largely similar bill from House Democrats.
Healthcare reform, in short, has entered a new phase, moving out of the purgatory of think-tank policy papers and rampant speculation and into the realm of actual legislation. If Congress finds a way to overhaul healthcare this year, many of the ideas adopted will likely come from these two efforts.
The proposals are not identical, but they are similar. They would require almost all Americans to have health insurance and would subsidize the costs for lower-income people. (In the House's version, which is less generous than the Senate's, individuals making up to $43,320 a year would qualify for subsidies.) And they both call for setting up centralized clearinghouses—called "exchanges" or "gateways," depending upon the bill—that would let Americans comparison-shop for healthcare plans.
The proposals are also notable for what they don't say, especially on controversial points. Kennedy has previously voiced support for letting people buy health insurance from the government, i.e. a public option, but his draft bill doesn't offer any real details. Rather, on Page 111, under the header "public health insurance option," there is merely a bracketed phrase: "policy under discussion." The House bill, by contrast, does call for a government-run insurance option. Yet neither bill addresses outright how to pay for reform.
These omissions are not oversights; they are political calculations. The cost of healthcare reform could top $1 trillion over the next decade, and the proposals for raising that money, which include everything from eliminating tax breaks for employers to putting new taxes on drinks that contain high-fructose corn syrup, are contentious and risk alienating lawmakers.
Meantime, in the past two weeks, Democrats' support for government-run insurance tocompete with private insurers to lower costs has provoked a strong blowback from Republicans and even created some intra-party turmoil . In fact, even before Democrats had released the outlines of their bills, nine Senate Republicans sent a letter to President Obama last week warning him that government healthcare "would create an unlevel playing field and inevitably doom true competition."
Democrats aren't taking these criticisms lightly. Speaking at a recent healthcare forum in Washington, Senate Finance Committee Chairman Max Baucus characterized the Republicans' letter as mere "positioning" and said that he has been meeting daily with key Republicans to persuade them to support a public option. "We are on the eve of doing something terrific," Baucus said.
Democrats seem to have the public on their side. A new Kaiser poll released this week finds that roughly two-thirds of Americans say they support a government health insurance option. More than 60 percent said healthcare reform "is more important than ever."
Like Kennedy, the more centrist Baucus is writing a healthcare bill. And like Kennedy's plan, which is being spearheaded by Sen. Chris Dodd as Kennedy battles brain cancer, the Baucus bill is slated to get out of committee within the month. The Dodd-Kennedy effort kicks off in earnest on Wednesday, when their Senate committee starts trying to fill in the gaps in their bill during a scheduled week and a half of debate.
At some point, the two Senate bills will be melded together. As head of the Finance Committee, however, Baucus has the added challenge of finding ways to pay for everything.
On that front, the administration says it has tried to do its part. In his weekly radio address on Saturday, Obama said he has identified about $950 billion in savings to offset the cost of reform, including more than $300 billion in savings from federal programs for the elderly and the poor. Though the proposals were short on details, top officials have pledged that all of these dollar amounts will be easily verifiable and rigorously checked by the Congressional Budget Office. Now it's up to Congress to come up with the rest.
- Read more about cutting healthcare costs.
- Read about Obama and healthcare executives working together.
Reader Comments
Healthcare Reform
As a healthcare administrator for a critical care practice, we see the most dollars being spent in the last waning months, weeks, or days of life for many of our elderly critical care patients, often at the behest of family members no matter the expected eventual outcome or cost. If we don't begin to have the conversation as a nation about rationing healthcare and limiting spending our dollars for care that truly will meaningfully preserve and prolong life, then we are missing a key component of this debate.
I am also not sure how mandated individual insurance coverage
would be enforced. Would there be a task force formed to make sure people are buying health insurance? What happens if they lapse in premium payment? Can they be reinstated? If fines are imposed, how would those get collected and who gets paid the fine money?
As a small group employer, I would like to see costly insurance coverage removed from the backs of small employers who are increasingly opting not to offer coverage to their employees due to prohibitively rising costs by private insurance companies. There does need to be more competition so that people can choose their own plans, much like they comparison shop for auto coverage. Maybe that means changing insurance regulations so that plans can be nationwide instead of regulating and licensing companies state by state so that the risk is more widely spread and therefore more affordable.
Malpractice suits are becoming ridiculously common, so torte reform needs to be part of any package. Of course doctors are often ordering unecessary tests to cover their hides, they have to in order to prevent being sued for fear of missing something. Malpractice premiums are soaring, which gets passed onto the consumer in the form of higher fees, like any other business.
Unfortunately I hear little talk of regulating prices for insurance companies and pharmaceutical companies, which (sadly) speaks to how much clout those two industries carry in our government. Why does the burden of paying for healthcare seem to be placed upon hospitals and doctors in the form of limited fees and regulations? Why are insurance & big pharma companies exempt? Physicians deserve to be paid well for their services when you take into account how much their education costs in years and training just to be qualified to do the job. It only takes a four year college degree to be a pharmaceutical or insurance company executive, and yet those industries are by far making the most money out of the healthcare.
I don't know what the answer is for reform, but I am not hearing what I believe to be viable plans from either side of the aisle.
A catalyst for change?
I am a National Healthcare Consultant who possesses years of experience with health policy reform. Based upon the past and current conduct of the key stakeholders, I am convinced that the primary participants are not prepared for the onerous and labyrinthine journey that lies ahead to meet Mr. Obama’s three health reform policy objectives. I maintain that we will have to experience a catastrophic event to compel all parties to the figurative table for substantive cooperation. I define such an event to be similar to the recent General Motor’s bankruptcy that brought the American auto industry to its knees. Here is an industry that has been aware of its internal problems for years, but had not been able to resolve the issues because the stakeholders’ desires were diametrically opposed. Once, GM emerges from the bankruptcy, I anticipate it will be a leaner company focusing on designing automobiles that travel over 100 miles per gallon, that cut emissions by 60% , and even reshape our American foreign policy. We will no longer amalgamate with regimes and foreign powers based upon potential oil reserves, but, instead, affiliate with countries that pledge an allegiance to our ideals and people. In sum, the health care industry needs to experience a symbolic bankruptcy to bring it to its bottom, which would rescind all parties’ hidden agendas and allow healthcare reform to flourish.
Health Care Reform Costs
“Obama said he has identified about $950 billion in savings to offset the cost of reform. As usual “he says” but we never see where if they even exist. “including more than $300 billion in savings from federal programs for the elderly and the poor.” We do not get the names of the programs or even what area of life they serve. His transparency is like a brick wall in a pitch black room. If they serve the poor why are they being cut? Do the poor and elderly no longer have value? Every time the Congressional Budget Office has given an estimate the actual cost has always been greater to much greater than that given by the Administration when in fact the CBO figures were even too optimistic and costs soared out of reason on many such instances.
advertisement
