In my first column, I mentioned the issue of health care reform as it applied to my own experience losing my health insurance last summer. Here, I’ll do my best to tackle the issue straight on. Given the scope of the issue, I will write three separate posts. The first will deal with what exactly is in the health care bills and why I think the Democrats should pass reform using reconciliation, a tactic that would go around the filibuster. The second will deal with what I think is the most likely result of the health care debate, which is an abandonment of real health insurance reform for small and ineffective “consensus” measures. The third will deal with how and why the debate on the issue has led us to this point.
The core of the health care reform proposals offered by Democrats is not as complex as critics claim. Reform proposals are based on several ideals and assertions. First, that our current health care system offers less than quality care and is on an unsustainable path toward bankrupting America. Second, it is Americans’ right to have access to quality health care, regardless of their socioeconomic level. Several specific goals have arisen from these assertions. First, to stop insurance companies from denying insurance based on pre-existing conditions and second, to provide universal, quality, affordable health care.
Democrats’ health reform proposals ban insurance companies from denying insurance based on pre-existing condition, mandate that all Americans buy health insurance, and provide subsidies and Medicaid expansions to help the poor get health insurance. To pay for these programs, they propose cutting out “inefficiencies” in Medicare, creating insurance exchanges to foster more competition and thus lower premiums, and increasing taxes (Senate taxes expensive health care plans, House taxes top .3% Americans). I will leave out the concept of a “public option,” because it think it is an aspect of reform worth sacrificing in order to achieve the other reforms mentioned above – nonpartisan analyses estimate the public option would cover little of the population regardless.
This doesn’t sound too radical, right? Republicans have been talking about inefficiencies in Medicare for years. Insurance exchanges seem like something Republicans might like; they do foster “competition” after all. The two most controversial issues are the insurance mandate and the increased taxes. In my opinion, the insurance mandate is a necessary step toward expanding health insurance in the United States. Increased taxes, though far from ideal during a recession, can be drafted to have as slight an impact as possible on average Americans and would simply be necessary to pay for these costly proposals. The remaining parts of the bill have significant bipartisan support. However, the controversial and less controversial proposals are all linked – you cannot have one without the other.
If you are going to force insurance companies to cover people with pre-existing conditions, you must have an insurance mandate; otherwise individuals will simply wait until they get sick to buy insurance, and premiums will rise substantially. If you mandate that everyone buy health insurance, you must provide subsidies and expand Medicaid; otherwise a huge proportion of Americans will not be able to afford health insurance. If you expand subsidies and Medicaid, you have to find some way to pay for it, thus the Medicare cuts and increased taxes. So it’s kind of an all or nothing sort of deal.
That is why the Democrats are faced with one acceptable option in my mind. They should pass using reconciliation a bill similar to the bill passed in the Senate. However, they should get rid of the ridiculous back room deals with Louisiana, Nebraska, and the Unions, and replace the tax on Cadillac health plans with the House’s tax on the wealthiest .3% of Americans. For those who don’t know, reconciliation is a parliamentary tactic that would allow Democrats to pass the bill using only a simple majority and thus avoid a filibuster. This move would be hugely unpopular and damaging to Democrats in the Midterm elections. But wouldn’t it be great for a political party to do what is right instead of what is politically easy? The Republicans had no problem passing several of Bush’s tax cuts using reconciliation.
Why won’t the Democrats pass a bill that expands health insurance for those that are sick and in need using the same parliamentary tactic? Oh yeah, and did I mention Bush’s tax cuts have cost America as much as $2.48 trillion (52% of which went to top 5% of Americans) and the health care bills are estimated to cost less than $1 trillion over the next decade and decrease the deficit in the long term. I’m not saying $1 trillion isn’t a significant sum, but America really needs to re-examine its priorities if it spends more on tax cuts for the wealthiest 5% than on expanding and improving health insurance.
This is my reasoning for supporting serious health insurance reform. I think our current system is not only unsustainable cost-wise, but does not provide Americans with high quality health care; I also think it is important that America provide universal health insurance. I don’t agree with all aspects of the legislation and I don’t agree with the manner in which the bill was drafted by House and Senate Democrats. However, the Democrats’ only good option now is passing the bill using reconciliation. This, from my view, is not likely to happen. Democrats will instead give up on comprehensive reform and try to pass small reforms in a piecemeal manner. Look for my next column, part 2 of 3, for more on why this is a bad idea.
Don’t Miss Part 2 of 3 Next Tuesday: Why Democrats will not pass the bill using reconciliation, and why, by not doing so, they doom reform to failure
Also, Don’t Miss Part 3 of 3 Two Weeks from Today: How Democrats, when having all the cards, screwed up so badly that reform is going to fail
{ 3 comments… read them below or add one }
Mr. Davis:
I find it hard to believe you say it is a RIGHT to have health insurance and that Insurance companies should not be able to deny you for pre-existing conditions. I will be the first to say that reform is needed. But if we allow all pre-existing conditions to come into play. You will see with your car insurance, being able to add collision coverage AFTER you crash your car. Should you be able to add sump pump back up insurance AFTER your basement floods?
I would be in favor of a system that would not deny you for pre-existing conditions IF and only IF you played the game correctly. If you always had insurance, and got sick, I would be ok with you being alllowed to get coverage. However, you see a lot of people who make enough money to purchase insurance, but choose not to and then develop a serious illness. Those people should not be ENTITLED, as you say to insurance for a condtion that becomes pre-existing. I have always referred to insurance as “in case ya”. Meaning you need it in case something happens, not after it happens. Maybe I can buy a life insurance policy two days before I die.
I think you need to re-think your article.
Thanks for your comments Eric. I think you are missing one of the main points of my article in your critique. I strongly agree with you that individuals should not be able to wait until they get sick to buy insurance. This is why, if Congress is going to force insurance companies to cover individuals with pre-existing conditions, they must also mandate that everyone buy health insurance, and enforce this mandate using strong penalties.
Otherwise, as you correctly say, individuals will simply wait until they are sick to get insurance, and premiums will rise making others pay for insurance companies being forced to cover these individuals. One of my main assertions is that Democrats’ health proposals are linked – you cannot stop insurance companies from denying based on pre-existing condition without a mandate, and you cannot have a mandate without further subsidies to help the poor buy insurance. I am not in favor of providing insurance to individuals who try to game the system; with strong penalties to stop people from gaming the system, instances such as these should be minimized.
I think the road the Democrats are embarking on now is a dangerous one (as I will say in my next article). Passing some of these reforms and not others could have a far worse effect than not passing any at all. But passing all of them would be the best option.
Short, sweet, to the point, FREEecxlaty as information should be!
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