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.