The "Other" Health Care Issue
President Obama took to the airwaves last night to argue for comprehensive health-care reform in the face of increasing obstruction from Republicans and skepticism from "moderate" Democrats. There has been tremendous public debate over every dimension of health-care reform. Currently the key issues seem to be about cost - how much the bill itself will cost over the next 10 years, and whether it will succeed in reducing health-care costs in the long term.
Long-term care costs are important. As the refrain goes, if we fail to do anything, Medicare (and to a lesser extent Medicaid) will consume all of the federal budget at some point in the next few decades. And the administration has good ideas on this score, such as the Independent Medicare Advisory Council, which would have the power to modify reimbursement rates to create the incentives that lead to better patient outcomes at reduced costs.
But there are really two separate issues at stake in the health-care debate, and controlling costs is only one of them.
The other "health-care issue" is that close to 50 million people have no health insurance at all, and the rest of us have a lot less than we think. I don't just mean the fact that your health insurance policy may not actually pay for the care you need, as described by Karen Tumulty. I mean the fact that you have your body until you die, and you only have your insurance until you lose your job, or the next time you have to get medically underwritten.
It's easy to call this a moral problem, but it's also an economic problem. The current system distorts the labor market by restricting mobility and penalizes companies that do want to provide decent health care for their workers. It also pushes sick people into the public system (Medicaid), sapping government resources and pushing up taxes in the long term.
If we could simply have a health-care bill that creates a health insurance option open to anyone and subsidizes the cost for poor people - perhaps by taxing rich people - that would look like a major accomplishment to me. (Health insurance for poor people has to be subsidized one way or another, or else they will simply die; unlike a car or a house, you can't save money on insurance by trading in for a cheaper, healthier body.) Universal coverage used to be the goal of health-care reform. Now that we are deep into the legislative trenches, it has been replaced by fiscal concepts such as budget neutrality and reducing long-term cost inflation. But it seems to me the value of universal coverage was forgotten somewhere, and it is certainly something worth paying for.
Instead we have the following political situation. Moderate Democrats and Republicans can posture on the grounds of costs and incentives, without having to come out against universal coverage. President Obama has insisted on a budget-neutral bill, playing into the hands of the Blue Dog Democrats. Republicans are united in hoping to block any bill at all to weaken the Obama presidency.
I'm not paid to write about politics (actually, I'm not paid at all), but I think Nancy Pelosi might have this one right. She says she doesn't need a single Republican vote. Clearly the Republicans don't want anything to pass. But if there is a bill that provides universal coverage, and other benefits and risks that won't be clear until after the 2010 election, would you rather have voted for it or against it? I think the answer to that is pretty clear, which is why the Democrats should be able to pass this with zero Republican support. Of course, that assumes they can remember why they thought health-care reform was so important in the first place.
July 23, 2009; 11:21 AM ET
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