You might be wondering why I haven’t written about the President’s Health care bill. The reason is that I have very little to say.
This, I realize, is unusual. But the truth is that the president’s proposal is very similar to the Senate bill—which is not a surprise.
Nevertheless, I am very glad to see the proposal. I was worried that the White House had put reform on the back burner.
Will it pass? As always, I’m trying to be optimistic. But I think that everything depends on whether the White House decides to twist arms. The president will have to persuade House liberals that this is a good first step—and that we can worry about improving the plan over the next three years.
I would still like to see a public option, and I hope that, in the end, the federal government will wind up overseeing the state-based exchanges. But the legislation doesn’t goes into effect until 2014; that gives us more than enough time to improve on it.
The President also will need to keep an eye on Senate moderates. I would favor sending Joe Lieberman on a special mission to South Korea. A relative who is stationed there tells me that the demilitarized zone is particularly bleak this time of year.
There is no need to worry about the Republicans. They can be counted on to vote against any reform bill that even attempts substantive reform. Universal coverage is not their top priority, and they definitely don’t want to pay for it.
As for the details: I’m glad to see higher subsidies for those who earn less than $44,000 or more than $66,000—though I think that subsidies for a family of four earning less than $66,000 are still too low. I prefer the numbers in the House bill (See a table comparing the president’s proposal to the House and Senate bills here http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf. But the subsidies can be revised when we see just how much insurance is going to cost in 2014.
I’m delighted to see that insurers are required to pay a larger percentage of medical expenses; as regular readers know I think that high co-pays and deductibles serve as a barrier to needed care. But I would hope to see co-pays limited to 10% of medical costs for all families earning less than, say $100,000 , not just for families of four earning less than $33,000. See second table here http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf , But again, these numbers can be amended .
I’m glad to see a tax on unearned (investment ) income to help pay for the bill. That money will help fund the $11 billion that the president promises for community centers over five years—more than the $ 8.5 billion that the Senate offered. This is an excellent investment; community centers have already shown that they can serve as medical homes.
When it comes to penalties for those who choose not to buy insurance, I’m afraid they are still too low. As Igor Volsky points out over at the Wonk Room, the president’s plan “may make it easier for younger Americans to opt out,” and we need those young, healthy citizens in the pool if we want insurance to be affordable for everyone. Volsky lays out the differences among the Senate, House and President’s plans in a clear, concise chart http://wonkroom.thinkprogress.org/2010/02/22/obama-health-plan/
Finally, since I can’t read President Obama’s mind, I’m not going to bet how this will turn out. I’m just glad that the White House hasn’t given up.
Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.
Filed Under: Maggie Mahar, OP-ED
Tagged: Commentology, health care reform, Maggie Mahar, Obama Feb 25, 2010
What poll are you looking at Nate? The one I saw was from Kaiser and they did ask very specific questions, not just “do you want reform?”.
To Peter’s point, that is true, Kaiser did not attach a price tag to anything, so maybe if they did, folks would have replied differently.
What the Kaiser poll shows very clearly is that if Dems fail to pass reform, along the current lines, there will be disappointment (38%) and anger (20%) aimed at both parties. This will surely translate into repercussions come November….
it was a CNN poll out yesterday
“there will be disappointment (38%) and anger (20%) aimed at both parties. This will surely translate into repercussions come November….”
Which third party will they be able to vote for then?
They will be playing musical chairs…I guess…
As an analogy, Congress is much like Phineas Gage, the famous case of the pre-frontal cortex injury in the 1800s where he lost executive function of the brain, but could still express right vs wrong. However, any decisions he made were made absolutely and only for immediate self-gratification and not based on any future outcomes potentials. As a sitting TBI Congress, we will not rehabilitate it. We need to replace it with some people with integrity who can actually accept the job and act for “We the people.” I doubt it matters much which party. We just need honest, straight-spoken people with functional frontal lobes.
“We need to replace it with some people with integrity who can actually accept the job and act for “We the people.””
We also need an electorate willing to reward politicians with re-election if they cast votes that require short term pain and sacrifice (higher taxes or less than unlimited end of life care, for example) from us in exchange for a more cost-effective, affordable and sustainable healthcare system over the long term. When I ask my favorite health reform question, what’s your contribution, “we the people” need to offer a credible answer.
Dear Maggie, I can not agree more with You.
I believe that we, the people who are getting screw up by previous 20 or more years by republicans governing, we must be more vocal and instead paying attention to pools, start writing about OUR needs and ideas on HEALTH CARE !!!
Whe we have (in this big country) just few big Health Insurances III. Maybe it is time to start looking for health care insurances in different directions. If Blue Cross is rising their members 39% , why not change provider???? why stay with dthose who are killing their own Members, by charging so much and giving so little??? We have thousands doctors who will do their job for less and help all of US with smmaller payments.Maybe it is start to turn back from corrupted doctors and look for those who truly want to help those who need them. Another thing is “ILLEGALLS WHO GET FREE RIDE ON ALMOST ANYTHING.cALIFORNIA PROBLEM IS AESPECJALY, BECAUSE JUST THAT!!!! It is time to get in office a new blood, and get those with experience-corrupted OUT from office and vote for TERM LIMITS on Congres and Senat. How people in a such old age are running OUR COUNTRY. Some are complaining that we can not put in office someone with no experience, well!!! most in Congres are with more then 15 years of, and what they are doing??? screwing US on everything.They have a lot of experience doing just that!!!
Thank you for the many comments.
On malpractice, take a look at Texas: caps on torts has not capped over-treatment (or over-spending.)
Dan M: Thanks for the kind words.
I don’t think we’ll end up with incremental compromises. On the Sunday morning shows (this morning) the REpublicans made it pretty clear that they are not intersested in compromise. Mitch McConnell stated that no Republican would vote for reform– even if the Democrats offered to add tort reform to the bill.
The Republicans don’t want to cover 30 million people.
Peter–I agree with much of what you say. But if we don’t embrace this first step toward reform, we won’t get anything for at least 3, probably 7 years. By that time, universal coverage will be unaffordable–whether by single-payer or some other means.
Single payer savings just aren’t as great as some say. The Commonweaelth fund estimates that a government plan would cost a family about $2,000 less than a private sector plan: $11,000 instead of $13,000 in today’s dollars. That’s probably about right. Note that most other developed countries do NOT have single-payer– only Canada and the UK. And they pay much less than we do, while receiving care that is, on balance, better.
If we vote for the current plan, a few years from now I’m pretty confident that we will have a public option. If that proves a huge success, we might gradually move to single-payer. That’s the only way we’ll get there–and I still would prefer a hybrid private/public plan with non-profit insurers competing with the government plan.
What would you do if Jed Bush–or one of Bush’s daughters–is elected president at some point in the future– and the conservatives re-take Congress? Imagine what they would do to a government health care plan. . .And you would have no other options. (This is what happened in the UK when Margaret Thatcher took over.)
To really put a lid on health care inflation, we have to stop overpaying for products and healht care services, and we need to stop paying for unncessary tests and procedures while also greatly reducing the number of medical errors that add to costs. That’s all in the Senate and House bills–under Medicare reforms.
Medicare is already cutting fees for diagnostic testing and cardiologists–beginning this year.
Medicare reform is already beginning and if we have reform legislation, it will pave the way for rational cost-saving throughout the system.
Bottom line: Barry wrote: “We also need an electorate willing to reward politicians with re-election if they cast votes that require short term pain and sacrifice (higher taxes or less than unlimited end of life care, for example) from us in exchange for a more cost-effective, affordable and sustainable healthcare system over the long term.”
I really think everyone should think about this. We’re at a point of no return. Either we begin to try to cover everyone and control spending (which means letting Medicare lead the way by cutting reimbursements and raising co-pays for UNnecessary and Unproven tests and procedures) — or in another 9 years, health care premiums will double.
That means that the middle class and most of the upper-middle class will not be able to afford insurance–or much health care.
No doubt some low-cost providers will pop up to help us out (probably primarily foreign-born foreign-trained physicians who now take care of our poor). But it will be very, very hard to find a low-cost hospital. Or affordable surgery.
We wil wind up with a sharply tiered health care system–much like the systems in some developing countries–where only the very wealthy will receive care.
I imagine the government will try to continue to take care of the elderly- after all, they have paid into Medicare for so many years. But as Medicare adds to the deficit, our economy will suffer.
If we actually choose that path (I don’t believe that we will) we will wind up a second-tier economic power with third-world health care.
how is this a free country, if one has to prostitute oneself to corporate america to obtain health care for one’s family. that enforced dependence is frankly a form of slavery. what has become of the american dream. and i’m not talking about people who want to follow festivals selling tie-dyed t-shirts. there are plenty of potential small businesspeople who would be able to support themselves with their enterprise if they didn’t have to make sure they have two million dollars in the bank in case of a health emergency in the family, and because they have an aging parent. you simply are not ‘free’ if being self-employed is not an option. i’m frankly astounded that conservatives — many of whose parents made started out as small businesspeople raising families — are not raising cain about this.
anyone who thinks it’s reasonable to expect people to *choose* between doing what they want to do for a living and insuring their family is no less than a sociopath and no more than a corporate whore him- or herself who wants to drag the rest of this country down with them.
I think there needs to be a system with a knowledgeable Layperson, a Health care expert, and a Judge to review merit.