I’ve devoted many hours of programming on Albany’s Talk 1300 to discussion of health care reform – or, more properly, to health insurance reform – because the topic is important, complex and because, if the polls are to be believed, misunderstood to a disturbing degree. The current fiction seems to be that President Obama and Democratic party are heading for a replay of 1994, when the Clinton health-care plan wheezed to death in Congress.
Well, not hardly. While health insurance reform is hardly a done deal — and could still be derailed by a deeper economic dip or a major international crisis — the issue is actually on a fairly predictable path in a time of truly vicious ideological and partisan warfare. Now that Labor Day weekend is in the past and the country is back into its dominant routine the debate will resume and move to its inevitable conclusion – a plan disliked by the left and right alike and passed by the Democrats with or without Republican support.
While Obama won on a platform of change last November, it was largely change in the abstract. In concrete terms, there was no groundswell for sweeping change in health insurance in particular. Without some guarantee that reform would lower costs for the vast majority of Americans, the likelihood has always been that the closer the politicians got to enacting something new the more nervous voters would get about embracing it – especially when that change involves about 17 per cent of the economy during highly uncertain economic times.
Uniting Democrats has been a problem for every Democratic President. Ideological, regional and urban/rural splits always make Democratic members of Congress a quarrelsome bunch. Ultimately, though, Obama will successfully make the case to his own party members that they’ll rise or fall as a group on the passage of this program. The Democrats either can govern or they can’t, he’ll argue, and he’ll win that argument.
Here’s how the deal is likely to resolve itself? With a bill passed by both houses and signed by the President that takes this form:
1) Universal coverage for everybody. The final bill will contain a requirement that every American purchase a minimum, basic health insurance plan or pay an income tax penalty to defray the cost Medicaid incurs when the government has to pay for health care for somebody who gets sick without health insurance. In exchange for all these new premium dollars flowing in from what is now generally a young, healthy uninsured population unlikely to eat up money in claims, the private insurers will stop denying coverage to people with pre-existing conditions and will stop dropping people who get sick from their policies.
2) Low-income subsidies. Households with incomes up to 300 percent of the poverty line would be able to buy a basic plan through for no more than 15 percent of pre-tax income, with the balance paid for by government subsidy.
3) A variety of health insurance plans. Among the options would be lower-cost, high-deductible plans long pushed by Republicans.
4) Employer mandate. All businesses with annual payrolls that exceed $250,000 would be required to pay for at least half of the cost of a basic insurance policy for all workers and their immediate families or pay the government a progressive tax.
5) A tax on lavish health plans. A tax of 25 percent would be imposed on health plans with an actuarial value of $10,000 for individuals and $20,000 for families, indexed to inflation. The unions won’t like this part of the plan.
6) Malpractice reform. A federal cap on punitive damage awards except in cases of flagrant malpractice. That would lower malpractice premiums and reduce defensive medicine.
7- Cost containment. Every two years, a panel of independent health experts would propose a package of reforms and reimbursement rates to keep spending growth of Medicare and Medicaid in line with growth in national income. The entire package would be voted on by Congress and subject to veto by the president.
8)—Denial of treatment: The final bill will provide funding for increased research into the relative effectiveness of different treatments, along with the promise that the results would not be used as the basis for denying coverage.
Kiss goodbye to any thought of a single-payer system like Medicare expansion or the Canadian system, whatever their perceived virtues by some. A system of socialized medicine like the British system or the Veteran’s Administration health care system was never in the cards. This has been one of the big lies in this debate from the start. No death panels, either; another lie. No coverage for illegal aliens that doesn’t already occur through Medicaid. Coverage for abortions? By law, no federal dollars can be spent on abortion coverage. Poorer people using government subsidies will buy coverage from private insurers. If they buy policies that include abortion coverage, is that an example of federal dollars going to pay for abortions? At some point the courts probably will be asked to clarify that question.
A public option? A government-owned and –operated health insurance company to compete with the private insurers? There’s virtually no chance of that being in the final bill. It can’t pass the U.S. Senate. Obama has already said he doesn’t feel it’s crucial.
How do I know this? Because my news sources are not limited to partisan opinion blogs, e-mail campaigns or Fox News or MSNBC. It will take several more months before all the details are hammered out, but that’s the deal that’s overwhelmingly likely to emerge after all the screaming, yelling, shouting and name-calling dies down. Do I like every aspect of it? No, and that’s the beauty of the thing; everybody will dislike something about it. That’s how laws are made in a democracy. Nobody gets to be the emperor.