First, let's review the current context. Up to 45,000 people die each year because they don't have health insurance. The U.S. health care system is by far the most expensive in any industrialized nation, and our health outcomes tend to be worse than other industrialized nations. Although we are certainly good at treating certain things, like cancer, we generally get much less bang for our health care bucks. There are also problems with health insurance. Right now, if you have a preexisting condition and don't have insurance, you are headed for financial and medical disaster. Insurance companies also practice shady tactics, like rescission, which involves denying you coverage after you've made a claim on the pretext that they have found some small, unrelated thing in your health history (like some acne treatment) that you did not previously report. Finally, there are problems of runaway costs. If left unchecked, growing health care costs will bankrupt Medicare and the nation within only a few decades.
All of this is unacceptable. Completely and utterly unacceptable. And this bill is the last, best chance we have to do anything real. Now, will the current health care reform bills completely solve these problems? Probably not, particularly with the watered-down reforms that are now being proposed to win over shortsighted, egotistical senators. But here are five reasons why we should still support health reform:
1. New health insurance rules. Health insurance companies will no longer be able to deny people coverage for preexisting conditions or practice rescission. But, you might ask, won't the insurance companies then go bankrupt? How will they afford this? Won't they go out of business? This brings us to number 2.
2. The new individual mandate. Everyone will be required to purchase health insurance. This will increase the insurance pool and give insurance companies thousands of new customers. The mandate will lower costs for everyone and allow the insurance companies to play nice with things like preexisting conditions. But, you might ask, how will people be able to afford health insurance? Isn't it really expensive? This brings us to number 3.
3. New subsidies. Subsidies will be given to poor and middle class families based on a sliding scale. Even the more modest versions of health care reform would help around 29 million people to purchase insurance. This is a huge deal, and it is what we should morally do as a civilized nation. But still, you might ask, will a subsidy really be enough to buy good health insurance? This brings us to number 4.
4. New health insurance exchanges. The exchanges are one of the best ideas of health care reform. Right now, insurance can only operate within states. This limits competition, meaning that most consumers don't have much selection and that insurance companies have little incentive to cut costs. The solution is to let companies sell insurance in an amazon.com sort of way -- a big, national marketplace for people to price shop for their medical insurance. The pools of potential customers will be enormous and insurance companies, seeing this potential, will bid aggressively for the new business, thus reducing costs and increasing efficiency. Alas, the current exchanges in the legislation are smaller, open only to small numbers of people, and won't be open until 2014. Sen. Ron Wyden and (Republican!) Susan Collins are currently pushing an amendment that will open these exchanges to more people. I hope they succeed!
5. New Medicare reform and cost control. Even though Medicare is the most efficient medical coverage system we have, more so even than private insurers, almost everyone agrees that Medicare is not as efficient as it could be. The health care legislation will cut out Medicare Advantage, which basically funnels money to private companies to do what the government could easily do itself. It will also establish a Medicare Advisory Council, a panel composed of doctors and medical providers, which will provide guidelines for Medicare cost-control. In short, doctors will be making recommendations about cost saving and efficiency, not politicians. There is also good stuff about preventing medical errors, about increasing research into what kinds of care actually work, and about formulating programs to reward doctors who work together and provide less expensive care. It may be that this is the largest cost control measure the Congress has ever passed (as I've said before, the CBO projects it will cut billions from the deficit, even with the new spending on subsidies).
So, there you have it. If anything approaching this framework passes, I will be happy. As Ezra Klein writes:
The achievement of this bill is $900 billion to help people purchase health-care coverage, a new market that begins to equalize the conditions of the unemployed and the employed, and a regulatory structure in which this country can build, for the first time, a universal health-care system. Thousands and thousands of lives will be saved by this bill. Bankruptcies will be averted. Rescission letters won't be sent. Parents won't have to fret because they can't take their child, or themselves, to the emergency room. This bill will, without doubt, do more good than any single piece of legislation passed during my (admittedly brief) lifetime. If it passes, the party that fought for it for decades deserves to feel a sense of accomplishment.
For more on subsidies, read this report from the Center on Budget and Policy Priorities.
For more information on the exchanges, see Ezra Klein's piece here.
For more information on the exchanges, see Ezra Klein's piece here.
For more on Wyden and Collins's important amendment, see here.
For more about the waste of Medicare Advantage, see here.
For more about the waste of Medicare Advantage, see here.
For more about the Medicare Advisory Panel, see here.
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