OP-ED

The President’s Proposal

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.

Livongo’s Post Ad Banner 728*90

60
Leave a Reply

60 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
17 Comment authors
C. IalishelenaBabalu123Barry CarolCourtney Recent comment authors
newest oldest most voted
C. Ialis
Guest

I think there needs to be a system with a knowledgeable Layperson, a Health care expert, and a Judge to review merit.

helena
Guest
helena

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.… Read more »

maggie mahar
Guest

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… Read more »

Babalu123
Guest
Babalu123

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… Read more »

Barry Carol
Guest
Barry Carol

“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.

Geewiz
Guest
Geewiz

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… Read more »

Margalit Gur-Arie
Guest
Margalit Gur-Arie

They will be playing musical chairs…I guess… 🙂

Peter
Guest
Peter

“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?

Nate
Guest
Nate

it was a CNN poll out yesterday

Margalit Gur-Arie
Guest
Margalit Gur-Arie

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….

Nate
Guest
Nate

Margalit, how did this lil tidbit fail to get mentioned? “. An overwhelming majority of Americans, 73%, prefer that Congress either start from scratch (48%) or stop work completely on health care reform (25%). Obama’s Health Plan contains essentially the same policies as the bill passed by the Senate, with the addition of price controls for health insurance premiums. CNN buries the lede in its article accompanying the release of its findings, never mentioning that an overwhelming majority (73%) of the American public disapprove of passing a bill similar to the one before Congress, including four in ten Democrats who… Read more »

archon41
Guest
archon41

And step down extra hard on the hopelessly ill littering the sidewalk.
For all your grandiose talk, none of you are up to the battle with the medical establishment effective cost controls would require.

Nate
Guest
Nate

great there goes even that chance at a smile….you will stop at nothing to ruin insurance companies will you? Just for that I’m going to go deny some claims for no reason but I am having a bad day.

Dan M.
Guest
Dan M.

Geewiz – My only concern with scrapping and starting over is that I can’t see a way we end up anywhere different than where we are today. There are firm ideological differences with little inclination to compromise. If we’re going to be in the same place a year later why waste the year? David Brooks had a nice piece in yesterday’s New York Times discussing the calamities of educated, thoughtful healthcare strategy colliding with politics. The result is the House and Senate bills we see before us. I predict we’ll see compromise in small, incremental reforms so that both sides… Read more »

Peter
Guest
Peter

“Now Peter that isn’t fair at all the Republican plan passing would make me smile for at minimum a week or two.”
A week, really.
GOP Plan:
Sec. 103. No annual or lifetime spending caps.
without—
10 (2) cutting Medicare benefits for seniors;
I believe two things you oppose.