Before we get started, I’m going to state for the record that I am a godless Liberal and I have, at no point, worked in the health care or insurance industries. I am going to label parts of this blog post as either fact or opinion, and in no way am I going to get involved with President Obama’s initial proposal for health care reform, now being referred to as health insurance reform. His proposal was vague and concicted of eight principles he announced in February 2009. I’m addressing the House bill, passed before the August recess, the proposal passed by the Senate Committee on Health, Education, Labor and Pensions (HELP), and the one that was before the Senate Finance Committee before the August recess, which has not been finalized.
Be warned, this post will be long. Something this important can not and should not be compressed down to simple sound bytes. (Opinion) Anyone who tries to do so is being either unconsciously ignorant or consciously deceptive. For my reference I am using an interactive side-by-side comparison set up by the Kaiser Family Foundation.
First things first: (Fact) We do have Federally funded health care already in this country, and it’s referred to by three names- Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). Only the Senate Finance Committe proposal is addressing Medicare and may lower the elligibilty age to 55. All three plans are proposing expanding Medicaid to everyone with an income of 115% – 150% of the Federal poverty level. (Opinion) I would expect to see the bill to reach President Obama’s desk to be close to the House bill’s proposal of 133% of the poverty level. Medicaid is partially funded by the states, so this would add a burden to state governments, who have begun to realize throughtout the nation that an era of lowering taxes has put them in danger of having to cut essential services and programs.
Second: (Fact) All three proposals require inidividuals to have minimum insurance coverage. The finance committee has not finalized a penalty. The penalty under the other two proposals would be $750 (Senate HELP) or 2.5% of Adjusted Gross Income (House). Exemptions vary between the plans but all include poverty. (Opinion) I think that the House proposal is full of loopholes for the individual mandate. Otherwise, I have no problem with mandating inidividuals have health insurance. This is an issue of public health and safety. (Still Opinion) When people don’t have insurance, they go longer with illness before seeking medical help, and run the risk of infecting others. People with health insurance get treated more quickly. It’s a public safety issue.
Third: (Fact) The House and Senate HELP bill mandate employers to offer and partially subsidize Health Insurance for their employees. The Senate HELP committee exempts employers with 25 or fewer employees. The House bill has a tiered system of reduced obligation. The Senate Finance committee may or may not mandate employers to do anything. All three plans propose a tax credit for small empoyers to offer health insurance. (Opinion) There most likely will be a mandate, but penalties will most likely be reduced to a point to limit its effectiveness. It all depends on the Senate Finance commiittee.
(Honest Opinion) All three plans get very confusing when it comes to reforming the insurance industry, but all seem to be consistent in restricting how insurance companies pay benefits. This is most likely where the reform will run aground. I tend to side with proponents of a single payer system for this reason. I’m not naive and I do realize that laws need to be specific to be effective. Simplicity is nice, but but it makes for a corrupt system. Even if we ever get a single payer system, it needs to be complex, because the health care system is complex.
However, the proposals have established a minimum requirement for health insurance and the establishment of a basic “public option” either through an expansion of Medicaid and Medicare ould leave the market open for insurance companies to offer broader plans that offer broader coverage. This does however, put legislators and bueracrats in a position to determine when someone’s condition does not qualify for coverage. It looks like a public option is not going to be able to pass in the Senate and instead we are going to get public co-ops. I think this is wrong as an individual mandate without sincere effort to restrict costs penalizes the poor.
(All opinion now) Reform is needed in Medicaid, Medicare and the Insurance industry. For the Insurance industry, this is addressed in the three proposals for adding regulation. Sorry, small goverment friends, if there’s anything we should have learned from the recent economic crisis, is that important industries do need to be regulated. Medicaid and Medicare need to have improved oversight in order to find fraud and refer it to the Justice Department for prosecution. This would be an expansion of the Center for Medicare and Medicaid Services, and I would suggest a Director to oversee the Center, one that reports directly to the Secretary of Health and Human Services, and would have to have their appointment confirmed by the Senate, to preserve the constitutional system of checks and balances.
The problem really comes in paying for such a radical overhaul, and a limited single payer system would be instrumental in limiting medical costs, much of which comes from the administrative costs involved in numerous insurance companies and and the resulting administrative needs that places on healthcare providers. Reducing cost is key to limiting the financial burden such a reformed system would place on the budget. In the meantime, we should repeal the Bush tax cuts for the wealthiest Americans. In the future we could see those return, but for this time, we cannot afford to give tax relief to some while those that need it most go without tax relief. Will we need to raise taxes? In our government, tax increases are a last resort, and in my opinion, it should remain that way.
I think a complete single payer system could work very well, but I do not think that a UK-based system would benefit us. I also think that we would need to see the tax burden on some or all Americans increased to afford it. We do need to ask ourselves, though, if this is an issue that in our time, needs to be a right to all Americans.
I think that it needs to be, and to hear this atheist say it may surprise you, but it is Judeo-Christian values that need to guide those of you that do believe to that goal. We need to look out for each other, and when our brothers and sisters are sick, we should see to it that they can get well. For while I appeal to Judeo-Christian values, I personally believe that these values are human values and that we look upon our neighbors as our family, and it is for our family, that we need to make these changes. If you are a believer, then take away these words:
He will reply, ‘I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.’
-Matthew 25:44
So let’s commit to universal health coverage for all Americans. Let’s do it because it benefits all of us when communicable diseases are stopped early. Let’s do it because it will save people from bankruptcy as the side effect of catastrophic illness. Let’s do it because it will ease our minds to know that we cannot lose our health coverage. Most of all, let’s do it because it’s the right thing to do.
