"Bi-Partisan" Health Reform?

On Tuesday October 13^th the Senate Finance committee reported out a “bi-partisan” health care bill. Bi-partisan generally means that a bill has garnered the support of two opposing political parties. The Democrats were so thirsty to claim the mantle of bi-partisanship that they relentlessly courted one Republican Senator, Olympia Snowe from Maine to win her support. However, in order to win just this one Republican vote the President was willing to abandon his campaign pledge of a pubic option, even in the face of strong public support for a government run option. Outing Senator Snowe’s tentative support President Obama stated the we have reached a “critical milestone” and that “we are now closer than ever before to passing health reform.”

Why the fear of a government option. Well according to the critics of such a plan, the government is not capable of running anything, and f there was a government option it would be unfair competition for private insurers. This spurious argument does not make sense. Firstly, if the government is not capable of running anything, then he private insurers would have nothing to fear form a poorly run public plan. On the other hand, if the government can run a health insurance program more effectively and efficiently, then the private insurers would have competition that would draw customers away. Is it really the role of government to insure the profits of private corporations? Perhaps since the massive and ill-conceived bailout of financiers who are now reaping huge bonuses for their failures, this is now an accepted government role.

So the real question is could the government run a national health care program and do it more effectively and more efficiently than private insurers, and if this can be done shouldn't this be something that all of our elected officials should support? We have vast experience with government-run health care programs. Medicare serves millions of older Americans and the Veterans Health System serves military veterans. Recent studies have shown that the users both of these systems are overwhelmingly satisfied with the service that they receive. Medicare received a 68% approval rating form its users, while private insurers only received a 48% approval rating. In a 2008 survey of the Veterans health programs, 79% of participants gave the VA a rating of excellent or very good. So, in actuality it would seem that the government is a better provider than private insurers. The real question then is why did President Obama take the public option off the table even before the debate really began, is the appearance of b-partisanship more important that ensuring that everyone has access to quality, affordable health care?

Let’s take a look at a quick overview of the Senate bill that the President has declared a “critical milestone.”

The major changes that this bill will bring to fruition include:

1. Requiring all US citizens and legal residents to have health insurance or face a tax penalty. Excluded form this mandate are American Indians, those for whom this would impose a financial hardship and individuals with a religious objection

2. Creation of State-based Health Insurance Exchanges: These would function as buying-cooperatives where small businesses and people without employer-sponsored health insurance can purchase policies of their own. The hope is that by creating these exchanges, individuals and small businesses who could not purchase affordable insurance would now have increased buying power through these exchanges. Small businesses could qualify for tax credits for providing coverage through these health exchanges, and individuals earning between 100-400% of the federal poverty level could qualify for federal subsidies to purchase insurance through these exchanges. Similar exchanges have been tried and failed in several states including Texas, California, Florida and North Carolina. These proposed sate-exchanges may just be another case of “everything old is new again.” This plan also proposes instituting penalties for employers with more than fifty employees for each of their employees who receives a tax credit for participating in the health insurance exchange.

3. Expanding Medicaid to serve people earning up to 133% of the federal poverty level. Individuals earning between 100% and 133% of the poverty level can choose to be covered through a health insurance exchange instead of Medicaid and receive a federal subsidy.

4. New regulations for insurers will prohibit denials for pre-existing conditions or to deny coverage to participants for treatments or illness. In addition new revenues will be raised through an excise tax on insurers whose premiums exceed certain limits, and an increase in taxes on pharmaceutical manufacturers, medical device manufacturers and health insurers.

5. Undocumented immigrants will be barred from participating in health exchanges even if they could purchase the insurance without government subsidy.

6. Limits abortion coverage by requiring that plans providing this coverage must segregate public subsidy funds from private premium funds, and abortion coverage cannot be required as part of a minimum benefit package.

A complete side by side comparison of the various bills curently in the House and Senate can be found at http://www.kff.org/healthreform/upload/healthreform_tri_full.pdf