To individuals, the already-passed House bill and under-debate Senate bill contain what look like attractive reforms.
Some citizens will pay more in taxes. Some, especially the young and healthy, will likely see out-of-pocket and premium costs increase. But there is reason to believe many Americans will find health care less expensive and finally within reach if a hybrid of the Senate and House bills is made law.
There is a genuine effort in both packages of legislation to ensure that low- and moderate-income individuals are not denied life-saving drugs, treatments and supportive services. The bills seek to make insurance more affordable and accessible, to varying degrees, through the following moves:
• Taxing wealthy Americans and top-end health plans
• Giving subsidies on a sliding scale to moderate-income families
• Expanding Medicaid, a program that insures the poor
• Eliminating Medicare co-payments for preventative exams, while cutting some existing benefits of Medicare Advantage
• Capping what people can pay for health care in a given year
• Offering a public insurance option for certain individuals
• Establishing minimum levels of coverage for insurance policies
• Eliminating pre-existing health conditions as excluding factors for getting insurance
n Increasing the number of people, especially healthy people, who pay into the insurance pool.
These ideas seem akin to the health care systems of Switzerland or the Netherlands, where universal coverage is achieved through private insurers.
Unfortunately, these ideas alone won’t necessarily reduce the overall costs incurred by the U.S. health care system.
Specifically, they don’t address the problem of moral hazard — insured patients, health care providers and drug companies having little incentive to forego expensive or superfluous treatments because someone else is trucking the freight.
They don’t address a payment structure that shifts the cost of care from one patient to another and from one insurer to another.
They don’t address the issue that major players in the health care dance — including insured patients and doctors — often have no idea what costs they are truly incurring.
And they don’t address the thorny issue of how to allocate scarce medical resources that could become even scarcer if more people have access to doctors and hospitals.
These bills could easily cost more and save less than anyone estimates, specifically because these deeper issues are not being addressed.
That’s because these aren’t just issues of dollars and cents. They are deeply visceral and emotionally charged. Who hasn’t known someone who has suffered the slings and arrows of our medical system — or been a victim of it themselves? Who isn’t wary of government promises of sweeping reform?
But doing nothing is not an option. Neither is ignoring the 800-pound gorillas that have so far been largely ignored or dealt with childishly in this debate.
It is not an option because individuals and businesses, especially small businesses, cannot continue to see health insurance costs climb as they have in the recent past.
What we ask from the Senate’s deliberations, and from the citizens anxiously lobbying their representatives, is a thorough and levelheaded evaluation of the pros and cons of this proposal.
The time to strike is when the iron is hot, and the chances for changing this legislation will only cool as the days pass.