Few observers are giving the health care reform bill passed by the House over the weekend much chance of survival as written.
The almost 2,000-page bill received only one Republican vote, and there were 39 Democrats who voted against it. Given the Senate is less ideologically tilted in the Democrats’ favor, it’s certain that senators are going to whack off the more controversial parts of the House plan.
Almost sure to be discarded is the so-called “public option.” Although the nonpartisan, credible Congressional Budget Office has projected that only 2 percent of Americans younger than 65 would actually opt to enroll in such a government-run insurance plan, opponents have demonized the idea, claiming the government plan would become an astronomical burden on taxpayers and put private carriers out of business.
The public option has gotten more attention and energy from both sides of the debate than it really deserves. If it has to be discarded in order to get meaningful legislation passed, then by all means toss it away.
What should not happen is for Congress to once again walk up the hill of health reform — as it has for decades — and come back down with little to nothing accomplished.
The current situation is untenable, not just for working Americans who can’t find, can’t afford or can’t keep health insurance but for federal and state treasuries, which are being sucked dry by the ever-increasing costs of health care. In 1980, according to USA Today, the federal government spent $72 billion on health programs, or about 12 percent of all federal spending. Today, the number will reach almost $1 trillion, or about 25 percent of the federal budget. Those numbers are projected to keep rising unless something dramatic is done.
If Congress does nothing else, it should do the following:
• Mandate that everyone gets health insurance and provide subsidies for those who truly don’t earn enough to be able to buy coverage without help. There is too much uncompensated care in this country, and most of it is delivered at the most expensive place to get treatment — hospital emergency rooms. The hospitals don’t eat the cost of uncompensated care. They pass it on to their insured patients in jacked-up prices — which drives up premiums, deductibles and, in the case of Medicare and Medicaid, the expense to taxpayers.
• Ban insurers from excluding pre-existing conditions. If coverage is mandated on everyone, insurers should not be allowed to cherry-pick whom they cover. When workers are enrolled in their employers’ plan, there is no scrutiny of their previous health history to determine eligibility. They get covered. Yet, if workers have to find their own coverage because they are self-employed or are employed by businesses that don’t provide insurance, they get looked over by insurers with a microscope. If applicants for insurance have a pre-existing condition, either it’s excluded from the policy or the premium quote is so high that they can’t pay for it and cover their other bills.
The driving force for reform should be to develop a health care system that is more fair. If we are going to guarantee treatment to people when they become sick, everyone — including the presently young and healthy — should help shoulder the cost. If we are going to require insurers to cover the chronically ill, insurers should be guaranteed a revenue stream from people who aren’t sick. If hospitals, doctors and other health-care providers are going to be paid for all of their services, they should moderate their charges.
Certainly, there are other issues to tackle. That’s why health care legislation runs into the hundreds of pages. But the bedrock reforms should be twofold: mandatory coverage for all and equal treatment from insurers.
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