Health Care Reform can’t wait
Barack Obama serves lunch to a patient during a visit to Barnes-Jewish Hospital in June.
A few days before the historic election that swept him into the presidency, Barack Obama was asked to name his top priorities for 2009. They were, in order, the economy, energy independence and health care reform.
Congressional Democrats have a different list. On Wednesday, two months before a new Congress convenes and Mr. Obama is sworn into office, Sen. Max Baucus, D-Mont., released an ambitious outline for health reform.
“I believe that Americans cannot wait any longer,” said Mr. Baucus, chairman of the Senate Finance Committee. Reforming health care, he said, is “essential to restoring America’s overall economy and the financial security of our working families.” He’s right.
Until now, the Montana senator hasn’t been associated with major health reform legislation. That’s been the province of Sens. Ted Kennedy of Massachusetts and Hillary Rodham Clinton of New York. But Mr. Baucus’ status may work to his advantage. He doesn’t carry the same negative baggage as either of his better-known Senate colleagues.
His 98-page proposal, which Mr. Baucus described as a “work in progress,” calls for covering America’s 46 million uninsured people and the additional 25 million people with poor insurance coverage. It would do so, in part, by opening up participation in Medicaid to anyone living in poverty. The federal government defines that as an income of about $17,000 a year for a family of three.
That’s very little money for a family to live on for a year, but in Missouri and many other states, it’s too much to qualify for Medicaid. Thanks to Missouri Gov. Matt Blunt’s mean-spirited 2005 Medicaid cuts, most working parents can earn no more than about $3,700 a year and still qualify for health care through the program.
Mr. Baucus’ plan also would allow people between the ages of 55 and 64 to buy into Medicare. That’s crucial. At that age, many Americans have one or more chronic illnesses that make it all but impossible for them to purchase health insurance on their own.
The Montana senator also would allow most people with disabilities to qualify for Medicare immediately. At present, they must wait two years before they become eligible.
Borrowing from a health reform plan in Massachusetts, Mr. Baucus calls for eventually requiring all citizens to have health insurance. That so-called insurance mandate has been opposed by many Republicans and some Democrats, including Mr. Obama.
During the presidential campaign, both of Mr. Obama’s major rivals — former Sen. John Edwards of North Carolina and Mrs. Clinton — proposed insurance mandates. Mr. Obama, instead, called for creating a health insurance program similar to Medicare for people without insurance. People don’t have to enroll in Medicare when they become eligible, but virtually everyone does because seniors typically can’t find affordable private health insurance.
Mr. Baucus says that an individual insurance mandate is necessary to end so-called cost-shifting, whereby the expense of treating the uninsured is transferred to those with insurance.
His plan contains another and even more controversial feature that originally was included in the Massachusetts reform. He would offer tax credits to businesses that offer health insurance to their employees. Large corporations that do not provide insurance eventually would have to pay into a fund that would underwrite coverage for the uninsured.
It’s unclear whether Mr. Baucus’ plan, even with solid Democratic majorities in Congress, could succeed or whether it could win the backing of Mr. Obama, who generally has favored more incremental changes.
But the consensus on the need for health care reform has never been broader. Mr. Baucus’ proposal is a good place to start the discussion about fundamental reform of the system that provides health care to all of us.
So as I understand it, Baucus would: (1) Expand free or highly subsidized coverage to more than 70 million people, at a cost yet to be determined; (2) Impose an individual mandate; (3) Create a national health insurance pool which would prohibit exclusion of pre-existing conditions.
Baucus asserts that the pool would create affordable coverage for all Americans. But current experience does not confirm this: State insurance pools provide poor coverage at high cost. For example, a 40 year old woman purchasing from the Missouri insurance pool would pay nearly $6,300 a year for a policy with a $2,500 deductible. Tennessee has a less expensive plan as part of their “universal coverage” effort: a 40 year old can get coverage for about $2,000 a year. But their plan has a 12 month exclusion of pre-existing conditions, a $25,000 a year benefit limit, a $10,000 limit on inpatient care, limit of 2 ER visits a year, and a bewildering array of other restrictions.
Imposition of an individual mandate will bankrupt many who currently choose to do without insurance, or who have policies which won’t meet the requirements of the mandate. Those who prefer to pay their own doctor’s bills, and only insure against catastrophic events, will undoubtedly be forced into more comprehensive - and more costly - coverage. For those who are not “poor”, the expense of this would go a long way toward making them poor. And, of course, somebody will have to bear the cost of providing subsidized or free insurance to those whose insurance doesn’t meet Mr. Baucus’s standards.
It is surely important to find ways to provide healthcare to the poor. But we must do so in a way that doesn’t bankrupt, or take choices from, the millions of Americans who are satisfied with their current health coverage. On this score, it appears that Mr. Baucus’s plan is just as much of a failure as previous efforts.
Nick Kasoff,
Who is Baucus? Baucus who ever he is I have never heard of. Is he one of those that we hear about who really runs the U.S.?
Nick,
Oops, joke is on me. I jumped the gun only reading your comment and assumed that you were calling Obama, “Baucus”. I am totally embarrassed and am awaiting your lashing. (lol).
Nick, don’t miss your opportunity!
This is almost the exact plan I had published in the PD a few years ago. The only thing missing is how he plans to pay for it. John, you know the answer to that. If this is the plan, all hospitals should be required to be for profit just like any other business since the government will now be paying for the healthcare for those that presently don’t have it leaving the hospitals paying for the indigent out of the equation.
In light of Obama signing FOCA, today’s article by Mr. Townsend said that Catholic hospitals will close their doors rather than be required to perform abortions leaving too few hospital beds plus Planned Parenthood would miss the income. Having all hospitals move to for-profit status and not be under government regulation to treat and pay for all who enter their doors would kill two birds with one stone.
Centrist - I couldn’t top what D. Walker already said. For once, I’m glad you can’t edit your comments after you post them.
As far as your comments on FOCA … unfortunately, being a private for-profit business will not take Catholic hospitals out of the reach of FOCA. If abortion rights extremists have their way, Catholic hospitals will be faced with the choice of performing abortions or closing their doors. It isn’t really much different than when they forced pharmacists to dispense the “morning after pill” despite religious or moral objections. I’m all for individual freedom. But one person’s freedom ought not trump another’s. Unfortunately, liberals don’t agree.
Nick,
You’re confusing the Missouri High Risk insurance pool — which covers people who, because of pre-existing conditions, are uninsurable on the individual market — with the concept of an insurance pool, i.e. group health insurance.
There’s no reason why a state or national insurance pool comprised on people who aren’t offered health insurance through an employer would have higher costs than a typical group health insurance plan. A high risk insurance pool, on the other hand, is composed by definition of the people insurance companies don’t want to cover because of their demonstrated need for expensive care.
Tennessee’s experiment with “universal coverage” ended a number of years ago, so I assume the coverage limits you’re talking about are also for its high risk pool. Again, that’s a very different arrangement than an actual insurance pool.
Coverage is cheapest when risks are pooled among a large group of individuals that include both the young and healthy and the older and sicker. The Baucus plan contains an insurance mandate because that way, there is no cost-shifting and the pool can work most efficiently.
People only “choose” to go without health insurance because they believe that they won’t need coverage, and that if something happens — they get into an accident or develop some serious illness — they’ll still be able to get care. But for that to happen, the rest of us have to pay.