It’s Christmas Eve and the Senate just passed a major health reform bill. Personally I think the reforms in it are relatively minor, but the passage of the bill itself is a screaming big deal. When I say minor, what I mean is that we’re leaving in place the inefficient employment-based health benefits system, and we’re expanding insurance mostly by putting more people into the separate but equal Medicaid program.
But this bill is a statement, and an important one.
For the first time we’re acknowledging that everyone ought to have health insurance and that those unable to afford it should be subsidized by the government. We’re also saying that insurance companies should take all comers at a consistent price without respect to health condition (and hopefully we’re implying that their job is to manage care not risk-select). Finally we’re saying that the majority of the cost can be paid for by redirecting inefficient spending within the health care system, and by taxing benefits that are only tax-free because of historical accident.
Building on those principles it may be possible to get us to a more equitable and more efficient health care system.
So whether or not you were like me (on balance) in favor of reform, anyone interested in health care should savor the moment. But realize that both after the conference (which will likely end up looking very like the Senate’s version) and the bill’s signing early next year, there’s still a long long way to go in the reform”.
And for some more fun, Ezra Klein asked a bunch of health care wonks to comment on what they’d like to see added in the Senate/House Conference. I was one of them. (I asked for 1. Freeing Health data, and 2. Making Insurers Responsible for Health outcomes) but you can see links to virtually everyone who commented at the bottom of the last and shortest of the dozen or so letters to Santa which Ezra got.
Categories: Matthew Holt