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Some models for health care reform |
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A couple things have come together today to point to what we may be looking at as models for health care reform. Some are good, and some are pretty bad.
First, there has been a great debate going on over at The New Republic over the Massachusetts health care plan. Diane Archer from the Campaign for America’s Future argues that Massachusetts is not a model for national reform, mostly because it doesn’t include a method to control costs. Jonathan Gruber, who helped architect the Massachusetts reforms, argues that doing coverage first leads to cost control in the future, and that Massachusetts got it right.
I’ve argued before that I’m not sure the notion that costs follow coverage makes sense. The best, and maybe only way to control costs is to have a competing public health insurance option, and if that option is as non-negotiable as the insurance industry says it is, then getting them on board for coverage doesn’t mean it will be any easier to control costs with a public insurance option later on. In the meantime, you’re just subsidizing poor-quality, expensive private insurance:
The public health insurance option is a bright line for opposition groups and it will always be. The insurance industry worries it will cut into their profits (and undoubtedly it will). Organized business groups are filled with ideological conservatives opposed to government anything, even if choice is preserved. And the AMA (which has been an enemy of health care reform since 1934 [pdf]) is worried that public insurance will pay them less. In other words, enemies of reform have been looking out for their profits for years, even at the expense of our health. I’m not sure why doing coverage first would change that incentive.
The public health insurance option is the big piece. Without that piece, any “health care reform” plan isn’t really worthy of being called health care reform. And getting that piece will be just as hard in the future as it is now.
Today, Anthony Wright of Health Access California (an HCAN state partner) argues that the Massachusetts model may indeed not quite apply, mostly because Massachusetts is a pretty unique state, with a long history of health care spending, a relatively rich and educated workforce, and a different state insurance market that’s already much more regulated. Instead, he points to California as a possible model:
The California proposal included significant public program expansions and these elements that went beyond Massachusetts: subsidies up to and above four times the poverty level; significant new insurance market reforms and rules on insurers; a meaningful employer contribution requirement to shore up on-the-job benefits; an option to get coverage through a public purchasing pool and public health insurance options; and the raising of significant new revenues to pay for the expansion.
And yes, the California plan looks like it’s closer to a national model than Massachusetts, probably because California is the world’s 6th largest economy, with the complexity that comes with it.
On the other side, today House Republicans released their budget proposal to counter the President’s. Or they released something they were billing as a counter-plan. Unfortunately, it was a bit short on details, as the media is pointing out. From what we can glean from the meager document, it looks like the Republican plan to restore the economy is to undo the recovery plan passed last month:
For an “alternative budget,” however, it is very short on numbers, including no mention of deficit implications. And the plan for creating jobs and sparking economic growth is actually undoing the stimulus and then cutting additional spending:
Republicans propose to undo the recent reckless and wasteful Democrat spending binge included in the so-called “stimulus” and omnibus bills. In addition, Republicans would cut overall nondefense spending by reforming or eliminating a host of wasteful programs deemed ineffective by various government entities.
Of course, stimulus dollars are already on their way out the door, so it’s difficult to envision how one would “undo” the bill. But even if it could be done, it would be an act of neo-Hooverism that would make Sen. Chuck Grassley’s (R-IA) insane three-year spending freeze look wise and prudent. In any case, this plan shows that Republicans are wedded to the notion that the country needs to “[limit] the federal budget from growing faster than family budgets,” when what it needs is the federal government to provide the demand that households can’t.
So yeah, the party of “no” becomes the party of “no new ideas.” And this applies to health care as well. Their “roadmap” to “universal access” and “affordable coverage” is a re-hash of John McCain’s health care plan, which was roundly defeated in the Presidential election. (Read for yourself, the health care section starts on page 6 of their plan.) America doesn’t want to buy private insurance across state lines, and they don’t think that’s the solution to our health care crisis. The Republicans do have a model for health care reform, but it’s an ineffective one, and it will get them laughed out of the room.
Finally, the President himself has a model for health care reform. At this morning’s virtual town hall (which I got to attend thanks to the DC for Obama Advocacy Team), President Obama laid out his thinking, which should be familiar to anyone who paid attention during the campaign:
So this is why any reform of the health care system I think has to address this issue, and to say we are going to allow anybody to get health insurance. And if you’ve got a preexisting condition you’re not going to be excluded but you’re going to be able to obtain health insurance. And if you can’t obtain it through a private plan then there is going to a public plan that is available in some way to give you insurance, or insurers are obligated to provide you with insurance in some way.
Clearly, there are lots of things we could pass through Congress that you could call “health care reform.” The question is, which ones will actually provide quality, affordable health care for all?
(also posted at the NOW! blog)
