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What Is "Reform?"


Earlier this year, the Obama administration expanded the Children's Health Insurance Program to cover 4 million more children. That was a good bill and a significant achievement. But it was not "health-care reform." It was a health-coverage expansion.

It's a useful difference. There are certain policies under consideration right now that could significantly change how the health-care system functions. A tax on employer benefits, for instance, that begins to reduce the primacy of employer-sponsored health coverage. A public plan that's accessible to all Americans. A Health Insurance Exchange that's open to everyone and can offer an alternative to both the employer and the individual markets. An individual mandate creates the expectation of universal coverage and a mechanism for achieving it.

But if those elements -- and maybe a few others I'm forgetting -- are stripped from the final legislation or significantly weakened, then the bill will not be a reform of our health-care system. It will be a coverage expansion. It might make certain improvements to the current system through insurance market regulations and delivery system changes. That might be, on balance, a hefty improvement against the status quo. But it will not be health-care reform. It will not change the fundamental dynamics of our current system. It might even strengthen them.

Photo credit: Marvin Joseph -- The Washington Post Photo.

By Ezra Klein  |  July 8, 2009; 5:29 PM ET
Categories:  Health Reform  
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I would disagree that taxing employer provided benefits is reform. It's a new tax. Reform needs to be aimed at reducing the "total" cost of health care - not adding to it. A tax simply makes health care cost even more.

But as Obama has said. The total $ into health care must go down for the outcomes (amount) of care we have today. Only then will expanding coverage be possible.

Bottom line is we need to spend the same $$ as the 2009 $$ and get universal care.

That is the definition of refrom to me!

Posted by: sailor0245 | July 8, 2009 6:38 PM | Report abuse

I almost wrote you this morning to complain that this term health care reform is being misused. In fact, the items that you posted over the last several days that you categorized as health care reform seem to me to be similarly mislabeled. I think whenever someone talks about how we pay for health care, this is specifically a discussion about health care coverage; that is, the only reform truly being discussed is an expansion of insurance coverage or the creation of a new entity that offers health insurance. When I think of the term health care reform, I think specifically of the issues raised in Atul Gawande's New Yorker article. In fact, in his article he clearly states that it doesn't matter how we pay for health care; the only way to control the rising cost of health care is to change the way medicine is practiced in this country. The terminology irritates me so much because I believe it allows the politicians to get away with doing as little as possible to change the current system by continually speaking about health care reform in a purposefully vague, and, to those who really are interested in the issue, misleading way. In other words, politicians don't have to be accountable for bringing only incremental change to the health care system; instead, they can celebrate reform, while continuing to appease special interests--as opposed to their constituents, ie the voters--because this term health care reform is not very specific and has not been adequately defined. By not demanding more specific language, we aid them in their mission to avoid bold and truly significant change to the medical system.

Posted by: goadri | July 8, 2009 7:40 PM | Report abuse

I think that this is your best health care post in months. Thanks for writing it.

Re: the points in it

I think that Obama was always aiming for adjusting the system rather than reforming it. Glad to be wrong.

--It might make certain improvements to the current system through insurance market regulations and delivery system changes.--

Those improvements are certain to be temporary. We'll be back here, in worse shape, in ten years unless we get on the right path now with actual reform.

Posted by: eRobin1 | July 8, 2009 9:44 PM | Report abuse

My read of all the discussion we're having about health care - we're adding millions of people to a terrible health care system.

That's a bandaid. Not reform. And it will jack up prices faster than you can say "'reform' didn't work."

Posted by: anne3 | July 8, 2009 10:38 PM | Report abuse

The problem with the Democrats is that they're always reforming stuff. This is about as productive as when the king of England managed his finances with the aid of a large checker-boarded cloth, on which gold, or the appearance of gold, was shoved from square to square.

"Reform", without the extension or improvement of existing care, always ends up the same way- all of the existing players stay in business at the same old stand. The fiddling with the margins is swallowed by the process. Everybody says how great it is that at least our nursing homes (hospitals)(doctors)(etc) didn't go out of business.

Medicare Part D is just a big extension of coverage, with government funding paying insurance companies to administer the program. Millions are alive today who probably would have died without it (I'm one of them).

And guess what- Walmart, which owns one of the biggest players in Medicare Part D, is feeling friendly towards expanding coverage. Well, duh!

It may be that the surest way to reform is to build an industry, let it crash, and then pick up any useful pieces.

Posted by: serialcatowner | July 9, 2009 10:05 AM | Report abuse

You can tax the taxes on my health insurance too and call it reform if you want. The rest of america see's a tax increase that Obama promised wouldn't happen to us makeing less than $200,00. Never mind us making $50,000 or less. Good luck with that.

Posted by: obrier2 | July 9, 2009 10:13 AM | Report abuse

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