Why Patch-and-Fill Won't Do
You can’t get there from here.
Not if there is defined as health insurance coverage for everyone in the United States, lower costs for the millions of insured who are being crushed by its price, and relief for employers who are burdened by an expense many wish they could wipe off their books.
And not if here is where the health insurance political debate is stuck.
At the moment, Republicans are gleeful and Democrats glum because of a Congressional Budget Office analysis — based on an incomplete and early draft of what is likely to be the most liberal-leaning health care proposal to emerge from the Senate — that shows the measure just won’t get the job done. The budget office says the partial draft put together mainly by Sen. Edward M. Kennedy, D-Mass., would reduce the number of uninsured by only about 16 million (out of upward of 47 million) and cost about $1 trillion over the next decade. That’s very little bang for a lot of bucks.
But no one should be surprised at either number.
For starters, candidate Barack Obama never ran on a platform to provide universal coverage. Of course he always said — then and now — that his goal was to cover everyone. But he has never put forward a concrete proposal for doing so, and hasn’t endorsed a firm mandate that everyone purchase insurance. Remember those primary-season debates in which rivals Hillary Clinton and John Edwards criticized him for this? Attention should have been paid.
Now President Obama has left the legislative “details,” as the White House likes to call them, to our esteemed lawmakers on Capitol Hill. This has fed an every-member-for-himself mentality, an instinct that needs no nourishment. Lawmakers of every political leaning are putting forward their own ideas, none of them as tough-minded or comprehensive as a single administration-initiated proposal might have been.
Why? Because senators and members of the House represent discrete districts that are driven by their own local and political imperatives. They don’t represent the country as a whole — nor, when the subject is as complicated and has so many regional differences as health care, should we expect them to.
The result is a raft of proposals that are patch-and-fill jobs on the current system — a system that pretty much everyone believes is crumbling to the point of collapse. This is an odd way to begin a major reconstruction project.
No one has seriously proposed concrete cost controls such as discount purchasing of prescription drugs by a government entity, which would demonstrably cut costs. In fact, the initial CBO analysis that my fellow liberals are so upset about shows not cost savings but a great deal of cost-shifting: The government would save money it now uses to subsidize tax-free insurance premiums, because some employees would drop workplace plans and purchase insurance through a new “exchange.” But this savings would only partly offset the cost of providing subsidies to those who can’t afford to purchase a policy outright.
Meanwhile, the private insurance industry would continue to be the chief source of coverage — and the only one, if the industry gets its way and Democrats produce legislation that does not create a public insurance plan as one purchase option.
Advocates of a single, national insurance system that would involve explicit cost controls and guidelines for care — that might put an end to such wasteful practices as over-testing — have been shunted aside. This is in part because Democrats quiver when Republicans call them “socialists.” But Republicans cry “socialist” even when Democrats promote weak reforms that barely nick the vested interests. That’s what’s happening now.
No one has seriously proposed an overhaul that would achieve what a single-payer system has been shown to accomplish in most other countries: universal coverage with lower costs that delivers better results than we now get in the United States.
Instead, Democrats have all but abandoned the idea that everyone be covered without exception. They’ve so far avoided endorsing clear cost-containment measures that would pass the budget-scorers’ test of legitimacy. The wished-for savings that Obama says he wants the private insurance industry to achieve are exactly that — wishes.
The winners so far are health industry lobbyists. They sense that their chances of protecting the interests of big insurers, drug companies, medical specialties, technology companies and the like are improving every day. They’re probably right.
Marie Cocco’s e-mail address is mariecocco(at)washpost.com.
© 2009, Washington Post Writers Group