It is clear to me that between the accusations on the Right and the denials from the Left that there is tacit agreement on what should not be in the new health-care legislation.
In summarizing what he calls "fabrications" by opponents of Congress' health care reform, the President said
We are closer to achieving that reform than we have ever been. And that’s why we’re seeing some of the divisive and deceptive attacks. You’ve heard some of them. Ludicrous ideas. Let me just give you one example, this notion that we are somehow setting up "death panels" that would decide on whether elderly people get to live or die. That is just an extraordinary lie. This is based on a provision in the House legislation that would allow Medicare to reimburse you if you wanted counseling on how to set up a living will or other end of life decisions. Entirely voluntary, it gives you an option that people who can afford fancy lawyers already exercise. That’s the kind of distortion that we’ve been hearing too much of out here.
We’ve heard that this is all designed to provide health insurance to illegal aliens. That’s not true. There’s a specific provision in the bill that does not provide health insurance for those individuals. You’ve heard that there’s a government takeover of health care. That’s not true. You’ve heard that this is all going to mean government funding of abortion. Not true. This is all, these are all fabrications that have been put out there in order to discourage people from meeting what I consider to be a core ethical and moral obligation, and that is that we look out for one another, that I am my brother’s keeper, I am my sister’s keeper. And in the wealthiest nation on earth right now, we are neglecting to live up to that call.
OK, so the President has addressed some of the contentious points and has dismissed them as "fabrications". Good. So it seems to me that this is a starting point for bipartisan agreement.
- There should not be government-mandated reviews of treatment options (i.e. "death panels): treatment should be strictly reserved to decisions made by patients and doctors.
- The new health-care bill should not cover illegal aliens.
- The Federal Government should not fund abortions.
Well that sounds like a good start to me. Put these things in plain language in the bill and we can be done with these: we can agree on these things, right?
Moving on, in his press conference on health-care legislation, the President promised that the new legislation would be "deficit-neutral"; meaning the changes would pay for themselves.
“the entire cost of that has to be paid for and it has got to be deficit-neutral. And we identified two-thirds of those costs to be paid for by tax dollars that are already being spent right now.”
I think everyone would accept this as a proposal. So let's work that into the bill. Now we have to recognize that none of the bills being considered by Congress at the moment are deficit-neutral, and that no plan that includes a "public-option" will be deficit-neutral without massive new tax increases.
More access and broader coverage do not save money, however. Greater coverage will increase health spending. Unless major changes are successfully implemented in health care delivery and payment systems, costs will continue to rise from a larger base at a rapid pace. Moreover, potential savings are speculative, while costs are far more certain. That imbalance suggests that unless there is broad popular support for the measures that will be required to achieve savings, the nation’s health care bill could become that much more unaffordable.
And FactCheck.org's analysis also finds that the current plans being considered do not pay for themselves.
The House bill doesn’t pay for itself, adding a net $239 billion over 10 years to the federal deficit, according to an analysis by the Congressional Budget Office and Joint Committee on Taxation. The Senate Health, Education, Labor and Pensions Committee bill is much further away from covering its costs. The CBO estimated that legislation would bring a net deficit increase of $597 billion over 10 years. The Senate bill, CBO said, only produced net savings of $48 billion (compared to current law), while the House came up with more money, saving $219 billion and bringing in $583 billion in federal revenue over that 2010-2019 period.
So if the President agrees the health-care proposals must pay for themselves and the majority of Americans think that as well, let's all agree and make that a hard requirement too.
So this all but eliminates the "public option" we're all agreed.
So good, we're making progress. (See how easy this is?)
Now, it is also clear that Americans do want health-care reform. They most definitely want to be able to get medical insurance if they need it. So I'm pretty sure we can all agree that insurance companies must not be able to exclude people for "preexisting conditions".
So let's add that to the bill.
And most importantly, Americans do not want to see double digit increases in their medical insurance payments each and every year like clock-work, so it is important that whatever bill passes, does something about costs.
Well one cost driver is medical malpractice insurance. So Tort-reform will be an important component of the new health-care bill. Even Howard Dean believes that tort-reform should be part of the health-care reform bill but at the moment, it has not been included. Why? Mr Dean explains
“This is the answer from a doctor and a politician,” said Dean. “Here is why tort reform is not in the bill. When you go to pass a really enormous bill like that the more stuff you put in, the more enemies you make, right? And the reason why tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on, and that is the plain and simple truth. Now, that’s the truth.”
So let's add tort-reform to the bill. (We're smokin' now)
Oh, and let's try some real competition among the insurers before me make the leap to government-run health care. Like let's let medical insurers sell insurance across state lines.
Devon Herrick, a senior fellow with the National Center for Policy Analysis who has written extensively on this subject, notes that insurance companies operating nationally would compete nationally. The reason a Kentucky plan written for an individual from New Jersey would save the New Jerseyan money is that New Jersey is highly regulated, with costly mandated benefits and guaranteed access to insurance.
Affordability would improve if consumers could escape states where each policy is loaded with mandates. "If consumers do not want expensive 'Cadillac' health plans that pay for acupuncture, fertility treatments or hairpieces, they could buy from insurers in a state that does not mandate such benefits," Mr. Herrick has written...
Interstate competition made the U.S. one of the world's most efficient, consumer driven markets. But health insurance is a glaring exception. When the competition caucus in Team Obama has to look for Plan B, this is it.
So it seems to me we could give that a try.
And how about replacing the current "fee for service" payment model that encourages doctors to order unnecessary tests with a capitation model whereby a fixed, per-patient payment is made to healthcare providers in exchange for delivering medical care to patients. This might focus health-care providers on providing services to patients instead of insurance companies and could result in competition among health-care providers since it would be in their interest to have more patients who trust them.
All of these things can be supported by a large majority of the population and none will increase the budget or the deficit.
And, I suspect, that a bill that has these general outlines will garner Blue Dog support and even more than a few Republicans fulfilling yet another Obama promise: bipartisanship.
And if such a plan doesn't garner significant Republican support, well then shame on them.