Health Care Reform: The Beach-Reader Edition
A midsummer status report on the big debate boiled down to the bare essentials.
By now you surely know this much: It’s August, there’s still no health reform bill in either chamber, and that’s a political setback for Barack Obama. This scorecard is not trivial. In a democracy, the politics matter.
That said, we’re talking about society-defining public policy here. How we get and pay for health care affects where we work, where we live, how long we live. It’s an industry that’s more than $2 trillion large, accounting for more than 16 percent of our gross domestic product in 2007. And our debt-ridden government already kicks in a whopping 40 percent of that money.
In short, health care reform presents many members of Congress with the most consequential and complex decision they’ll ever make on our behalf. So the policy details matter, too, and we’ve all got to know them. Problem is, the political fight is about to make an already dense debate incomprehensible.
Everybody involved is promising to come at you hard this month. House GOP leader John Boehner of Ohio will bring the fear: Big Brother wants to control your doctor. Speaker Nancy Pelosi (D-Calif.) is gunning for the insurance industry: It’s greedy, wasteful and craven. And the White House will narrow its focus on agreeable consumer protections—rather than the system-wide overhaul it’s pursuing.
What actually matters in this din of spin?
First, a resource for industrious readers: [Go here http://healthreform.kff.org/]. That’s the Kaiser Family Foundation’s Web site dissecting the reform debate, with a mix of plain-language tutorial and wonky research. It’s not 101, but it’s accessible info from a nonpartisan, nonprofit source.
For everybody else, at minimum you must know that the whole messy business now boils down to two questions: What, if any, public insurance plan will be created, and how will we pay to cover the roughly 50 million Americans who are currently uninsured? There are many, many other questions, but these are the fundamental ones upon which Congress remains the most deeply divided.
QUESTION #1: The Public Plan vs. Co-ops
President Obama has pushed the idea of creating a public insurance plan since his 2008 campaign, though with varying intensity and commitment. The idea is to contain the private sector’s excess—inflated costs, cherry-picked customers, dodged claims—by forcing it to compete with a government-run plan.
Ted Kennedy’s Senate Health, Education, Labor and Pensions Committee (appropriately known as HELP) already passed a bill with a public plan. But the crucial Sena
te Finance Committee—where bipartisan negotiations are unfolding—is leaning toward a bill that wouldn’t include one. Rather, Finance Committee Chairman Max Baucus (D-Mont.) and his colleague Sen. Kent Conrad (D-N.D.) want to build nonprofit cooperatives to compete with private insurers.
What’s a nonprofit cooperative? In the specific sense—meaning what Baucus, Conrad and the Finance Committee Republicans are considering—we don’t know, ’cause they’re not saying. Obama claimed in his news conference—you know, the one that turned out to be about Skip Gates rather than health care—that Finance hasn’t even told him what’s up. (Politically, Baucus and his buddies are likely keeping their cards close to see what’s possible in September.)
In the general sense, though, an insurance co-op is like any other co-op. The members run it, so they’re looking out for consumers rather than corporations. They’re not pursuing profit, so presumably they lower costs. And if a co-op is large enough and geographically broad enough, it’s got purchasing power that can also make it cheaper than private insurers.
Critics—including many of the Senate’s most powerful Democrats and the House leadership—call all of the above nonsense. They ague that the only version of a co-op that would be big enough and strong enough to truly compete with the insurance industry is a version Republicans won’t support. And the whole point of creating co-ops rather than just offering a public option is to get bipartisan support. At minimum, any competitive co-op would have to be national in scope, would need a massive upfront investment of public money and would have to pay providers bargain-basement rates.
The House, meanwhile, is all but certain to pass a bill with a public plan in September. But the central questions for the House’s public plan mirror those for Senate Finance’s co-op: Who gets to join, how much public money goes into it and will it be allowed to wrangle cheaper payments to providers? The last of these three has been the most contentious.