For weeks I’ve been reading the articles on health care reform and grousing because there are so few summaries of the 1000+ page bill. But I’m happy that some writers are finally talking substance rather than the politics of the bills or the uproar at townhall meetings (often over misinformation or dis-information, by the way).
Steven Pearlstein in the Washington Post last week wrote about the Republicans propagating falsehoods in the attacks on health care reform. He pointed out several main points of the bill, especially notable the “exchange” idea:
The health insurance exchange that individuals and small businesses could purchase insurance at lower rates than now available. It is this exchange in which the question of “public option” arises. Although the public option is in the House bills floating around, it appears that the bi-partisan Senate bill will probably opt for a “nonprofit cooperative” to take on the role of the public option, and the Obama Administration signaled in a number of press outlets this weekend its willingness to consider such alternatives to the public option.
The Sunday Washington Post had a “handy health care cheat sheet” by Alec MacGillis, although I think it needs to be honed down a bit more. In short McGillis points out that 47 million people are uninsured; and that health care costs have been surging. The proposed solution is making Medicaid available to more people and helping others to purchase insurance through the “exchange.” Everyone would be required to buy insurance. At the outset, large businesses and people receiving coverage from employers probably wouldn’t be able to buy on the exchange.
The cost of expanding coverage, according to MacGillis, would be around $1 trillion over 10 years ($140 billion/year). The funds would be raised by squeezing money out of Medicare and Medicaid from subsidies that go to private Medicare Advantage Plans and some other Medicaid funds.
The bills would set a federal panel to establish Medicare rates free of pressure from providers.
From the House Committee on Energy and Commerce there are a number of other provisions in their fact sheets:
* Guaranteed coverage – Insurance companies will not be able to refuse to sell or renew policies or exclude pre-existing health conditions. Prohibits lifetime and annual limits on benefits. Premiums can vary based only on age, geography and family size.
* Over time a minimum quality standard for employer plans will include preventive services with no cost sharing, mental health, oral health and vision for children.
* Caps on amounts person must pay out of pocket in one year
* Sliding scale affordability credits for low and moderate-income families and individuals.
* The exchange and inclusion of a public health insurance option (or cooperative option) will open many markets in area to new competition.
* Expansion of Medicaid to persons and families with incomes at or below 133 percent federal poverty level and will be fully federally financed.
* Filling of "donut hole" in Part D drug program, eliminating cost-sharing for preventive services and improving low income subsidy programs in Medicare, fix physician payments.
An excellent column by Paul Begala in the Thursday Washington Post warns against Progressives dumping the health reform effort because of compromises such as no single-payer plan or perhaps no public option. Bergala points out that every other major piece of social legislation had to make compromises in the beginning and gives some excellent examples of groups excluded from Social Security initially (agricultural workers and domestic workers) but who later have been included. Although we can be appalled that these workers were not initially included would we have wanted Roosevelt to veto the legislation?
Begala was part of the White House group advising President Bill Clinton in the early 90s urging him to veto any legislation that didn’t meet idealistic goals of real reform – Of course health reform did not get out of Congress in the 90s – it was dead on arrival. Bergala says, in effect, that this time we need to be willing to accept the half-loaf. I agree.
Everyone needs to write their Congressmen and Senators and express their views – however idealistic they may be.
But the bottom line should be: We need health care reform now. We cannot postpone this issue for another generation to decide. Let's begin the reform in 2009.
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