That cacophony that you hear rattling throughout the nation this August is the sound of health care reform being debated on the home front. The noise has become so distracting that it’s hard to imagine that Republicans and Democrats in Congress can agree on anything. Neither the House of Representatives nor the Senate have voted on a bill yet, but various proposals have been cobbled together in the House for a vote in September. But the Senate Finance Committee holds the trump cards in the process, and whatever bill emerges will have that powerful committee’s imprint.
Can the various factions agree on anything? The answer is yes. So if legislation does emerge from this summer’s meat grinder here are three points we can expect to see included:
- There is broad support between Democrats and Republicans for changing the way that physicians are paid, based on the quality of particular patients’ outcomes rather than fee-for-service.
- Likewise, members of both parties want to prevent the denial of insurance coverage to people with pre-existing conditions. Health insurers are also agreeable to this provision as long as everyone, healthy and sick, are included in the risk pool.
- Both sides also agree that a centralized on-line marketing site be developed where consumers can shop and compare the various plans available to them.
The primary point of contention between conservatives and liberals is whether to create a government sponsored public plan to compete against the plans offered by private insurers. President Obama maintains that such an entity will act to keep private insurers honest. The Democratic-backed public option would basically be a huge bureaucracy replicating Medicare, where the government sets the premiums and services. The Republicans hold that a public option will give the government too much control and would be an unfair competitive edge.
We believe that political realities are such that the public option won’t clear Congress, despite Democrat control of both chambers.
Of course another huge flash point is how to pay for it all. The Congressional Budget Office has estimated the cost of Obama’s plan will exceed $1 trillion over 10 years. Democrats would tax the wealthy to cover the costs. Yet the bar to affluence is set a lot lower today than in years past.
Finally, the parties are split over the issue of the employer mandate, that is, will employers be required to provide health care coverage to their employees? Democrats would impose an 8 percent payroll tax toward employees to buy it themselves if the employer doesn’t.
If the House and the Senate can eventually agree on a bill we think it will require heavy regulation of insurance companies and in place of a public option we’ll see regional cooperatives to offer acceptable public programs to compete with private plans.
With Congress in recess throughout August, there’s a lot of speculation and misinformation out there. That’s not surprising because lawmakers are attempting to remake one sixth of the American economy. It’s the most complicated piece of legislation ever undertaken and it will affect everybody. Keep checking back as we keep you apprised of the status of the debate.