Weekly Briefing

Why Congress has to pass comprehensive health care reform now

Here are two quotes that tell you everything you need to know about the so-called "moderate" U.S. Senate Democrats who are arguing for a piecemeal approach to health care reform now that Republicans have claimed what one insightful wag described as a "41-59 majority" - they come from Indiana Senator, Evan Bayh and Nebraska's Ben Nelson:

Quote #1: "Just ramming through a bill on a purely party-line vote on a strictly partisan basis will not do much to generate the kind of progress around here on other issues that we need," Bayh said of reconciliation. "We need to focus on things where we have a consensus."

Quote #2: "This is one where we need to make a pie a piece at a time, as opposed to a comprehensive approach," Nelson said. "We've tried a comprehensive approach and it's clear that won't be possible."

Got that? Americans elected a new president by a near landslide and put in place large majorities in both houses of Congress on a shared and specific platform of passing comprehensive health care reform and now, because of the fear of a few senators that they'll upset the sensibilities of some of their brethren in the House of Lords by passing a supplemental fix with less than 60 votes (they've already passed the main bill with 60 votes), everything must stop. How dare the majority rule?

A recipe for disaster

If this brand of "logic" weren't bad enough from a purely political, common sense perspective, there's also another small problem when it comes to the idea of baking the pie one slice at a time: it makes about as much sense in the health care arena as it does in the kitchen.

Here's the hard truth when it comes to health care reform: We'd all love it to be simple as, well, pie (and a piece of cake to understand and explain) but there's a reason that isn't possible - the only way to do it is to completely blow up the entire system and start from scratch with a straightforward, single payer, government-run system. And while one could make a good case that such an approach might actually make sense in a perfect world, it simply isn't going to happen in 2010 America.

So, given this fact and the fact that we simply must do something to: a) Bring tens of millions of uninsured people into the system, b) control explosive cost growth, c) abolish the twin obscenities of the "preexisting condition" and the hospital bill-induced bankruptcy, and d) generally prevent health insurance companies from becoming a metastasizing cancer on the American economy, the only realistic option is to pass something along the lines of what's been slowly developing in Washington over the last year.

Sure, it's complex and a challenge to follow and translate into winning sound bites, but that's what happens when you try to comprehensively reform a system that's already more complicated than War and Peace. What do people really think? That it would be possible to rein in one of the most complex and "lawyered-up" private bureaucracies in the history of humankind with a pithy little 20 page law? Heck, the budget bill for a modest-sized state like North Carolina is several hundred pages each year.

Capturing and controlling the current American health care system is like taming a giant and powerful river by constructing a giant flood control dam - it's not going to happen by adding a few concrete blocks to the river bed every now and then as Senator Nelson suggests. Too many parts of the system are dependent upon each other. The only possibility is to capture the whole thing all at once so that the new and improved system can be put in place in relatively short order. 

When American engineers and laborers built Boulder (now Hoover) Dam during the Great Depression, their only chance for controlling the Colorado was to dig enormous tunnels so that they could temporarily divert the river from its main bed. That's essentially, what the legislation under consideration now in Washington would do - it would give the American people a way to wrest control of our raging torrent of a system and bend it to our will for the service of all - rather than just those who are wealthy enough to hire the equivalent of a whitewater guide.

What's on the table

Generally, the House bill is stronger, but not in every case and with the adjustments to the Senate bill now under consideration (this is the issue that has Bayh and Nelson in a tizzy), the changes and improvements to our system will be quite significant and beneficial. Here is some of what the Senate bill will do:

Guarantees secure insurance coverage by:

• Preventing insurers from denying coverage to people with pre-existing conditions and by barring insurance companies from basing premiums on health conditions or gender, as many do now.
• Restricting insurers from raising rates when people get sick.
• Requiring insurers to devote at least 85 percent (80 percent in the individual and small market) of premiums to medical benefits. If insurance companies do not meet this threshold, they must provide rebates to consumers.

Creates affordable health care options for individuals and families by:

• Significantly expanding Medicaid, including to adults who are currently ineligible in most states. This will result in newly covering 15 million people.
• Providing subsidies to make health insurance more affordable for 20 million low- and moderate-income families.
• Requiring insurers to cap out-of-pocket costs for all families and by eliminating lifetime caps on benefits and medical services.
• Assisting small businesses in purchasing health benefits for employees.
• Extending funding for the Children's Health Insurance Program (CHIP) until 2015

Allows individuals and families to make informed choices about health insurance by:

• Creating "Exchanges" - i.e. marketplaces to compare and purchase certified health plans. The Exchanges will make it easier for consumers to find the best plan that meets their needs.
• Funding the immediate startup of state-based consumer assistance offices dedicated to answering questions about insurance options, assisting with enrollment, and helping to navigate the health care system.

Improves quality of care by:

• Promoting access to primary and preventive care; strengthening infrastructure by rewarding care coordination, innovation and efficiency within the delivery system.
• Shifting the health care system toward more patient- and family-centered care.
• Developing pathways to test and evaluate payment and delivery system reforms to improve quality and lower long-term costs.
• Including consumer representation in many of the key quality efforts.
• Establishing a national strategy to improve delivery of care, patient outcomes and population health, including reduction of racial and ethnic disparities.
• Expanding funds for prevention initiatives and targeting racial and ethnic disparities.

Strengthens Medicare by:

• Limiting cost-sharing for seniors enrolled in Medicare Advantage and by creating a new office dedicated to improving policies for some of the frailest and sickest elderly. It also promotes integrated care for beneficiaries who are dually eligible for Medicare and Medicaid
• Beginning to close the Medicare Part D "doughnut hole," or coverage gap. The bill increases the threshold at which Medicare Part D beneficiaries enter the coverage gap by $500, and it provides a 50 percent discount on the prices of drugs in the doughnut hole   

Going forward

Is the Senate plan perfect? Of course not. The insurance and drug industries and many others have thrown enormous wads of cash at the issue and have weakened it in numerous ways. But, especially in light of last week's U.S. Supreme Court decision completely unleashing corproate politcal spending, there isn't much chance that this problem is going to be abated any time soon. And, for all its flaws, the Senate bill remains a more or less comprehensive solution.

In short, it may not divert the entire river all at once, but it will cut the torrent down to size and give the foundation of a new system some chance to become established. Let's hope our leaders act before the health care flood gets completely beyond our control. 

 Email This Post  Print This Post

This entry was posted on Wednesday, January 27th, 2010 at 9:40 am and is filed under Weekly Briefing. You can follow any responses to this entry through the RSS 2.0 feed.