Health care has left the House

The current state of this country’s health care system is untenable and must be fixed. But that doesn’t mean that any fix is acceptable.

The bill passed by the U.S. House of Representatives late Saturday seems to fall into the category of “anything is better than nothing.”

Here’s why we see serious problems with that bill.

First, there is the tremendous cost of the legislation, pegged at $1.2 trillion over 10 years, although that figure may be reduced a few hundred billion dollars by some of the revenue-raising measures in the bill. The cost actually gets much worse after the first decade, because of accounting gimmicks used in the bill to keep the initial cost low.

This is something the United States can’t afford, either now as we struggle to fight our way out of a severe recession, or in coming decades when we will be confronted with pending demographic and economic train wrecks in both Social Security and Medicare.

Furthermore, even the numbers from the first 10 years are questionable. One way the bill manages to keep costs lower than they otherwise would be is by eliminating annual costs increases to doctors for Medicaid reimbursements — at least in the current bookkeeping. But Congress has regularly approved increases in Medicaid reimbursements for physicians and there is every expectation it will do so again, therefore driving the cost of this bill substantially higher.

On top of those direct costs to the U.S. Treasury, the legislation adds to the Medicaid costs of most states, which are already in extreme economic distress.

The surcharge on the wealthy that aims to reduce some of the overall costs of the House bill has already drawn the wrath of many people, including a number of Democratic politicians. That’s because it punishes those individuals successful enough to make more than $500,000 a year and discourages them from investing more of their money in job-creating enterprises. With unemployment now topping 10 percent, we should be doing everything we can to encourage job creation, not discourage it.

Then there is the issue of the so-called public option, a government-run insurance provider that would compete with private insurance. Under the bill passed by the House last weekend, the government plan may do more than compete with the private sector. It may create perverse incentives for businesses to drop private insurance. In many cases, it would be cheaper for businesses to eliminate health insurance for their workers altogether and pay the fines established in the bill, rather than continue to provide employee health insurances.

There’s more. In order to control costs, government oversight of the health care system will necessitate some limits on things like the use of MRIs or CAT scans, or decisions on when elective surgeries are appropriate. Will that result in European-style limits and delays in many medical procedures, as some critics contend, or will it simply result in a reasonable reduction in overused or unnecessary procedures?

The House bill isn’t without merit. It would ensure coverage to 96 percent of Americans, nearly eliminating the rolls of millions of Americans who currently have no insurance. And it recognizes that to make this happen, people cannot be allowed to voluntarily opt out of insurance. If they do so, under the bill, they would be subject to a fine. Also, it ensures people aren’t denied or dropped from health insurance because of existing conditions.

But the cost and the public option promise to be major impediments to the Senate passing a similar bill. There have already been declarations that the House bill is dead on arrival in the Senate.

If that is the case, it may yet be possible to fashion a health care reform bill that really addresses the most pressing of our health care problems with sensible cost controls and without threatening to drive private insurance firms out of business.


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