Why aren't the subsidies getting more attention?
I sure wish that overall subsidy levels in the current healthcare bills produced the same kind of uproar as abortion and the public option. In terms of real-world effect on real-world people, subsidies are the biggest issue by a mile. But not a very sexy issue, apparently. That's too bad.
I agree with that, of course. And it goes for payment reforms, too. But I don't think the problem is that the issues lack sex appeal. It's that they're not one issue. The public option debate has been about public option, yes or no, not about Medicare rates or networks. The abortion debate is about Stupak, yes or no. The subsidy debate is about subsidy levels, which are hard to communicate. It's become granular.
In part, that's because it is granular. Whether the subsidies are good enough or not depends on whether they reach high enough on the income ladder, do enough to offset premium costs and do enough to protect against out-of-pocket costs. That makes them complicated. A subsidy scheme that reaches 500 percent of the poverty line but only offsets 5 percent of premium costs is not a good scheme.
In retrospect, progressives probably should have settled on a final number that would have been sufficient to do health-care reform right. The problem is that that number -- $1.2 trillion, probably -- was high, and people were scared of it, even though the difference was only about $30 billion a year, which isn't a lot for the government, but would have meant a lot for individuals. And now, with $900 billion sitting out there as the apparent limit, there's not a lot that can be done on subsidies.
November 13, 2009; 3:58 PM ET
Categories: Health Reform
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