Monday, July 20, 2009

Why can't we reform health care one piece at a time?

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Today, President Obama ramped up the rhetoric in a renewed push for a health care reform bill, while giving significant ground by backing away from his insistence that Congress produce a bill before its August recess. Well he might, since the chance that the House and Senate will agree to anything is now zero, and even the odds of a bill passing one chamber are dropping by the minute.

The troubles besetting his "signature" proposal (the tag now used by many media, even though Obama doesn't have a specific proposal) are so many that the question may no longer be whether there can be a bi-partisan bill but whether the Democrats can muster enough Democratic votes to pass a partisan bill! House Blue Dogs and Senate moderate Democrats are far from sold on any of the various proposals popping up and down daily. Public support for a sweeping reform is fading, as voters catch onto the behemoth costs, the likely tax and/or premium increases, and the vagueness of the benefits. Meanwhile, Obama's honeymoon is over, and his standing in the polls is declining -- not a problem for him but a signal to Democrats in Congress that they need not fear him as much as they might have a few months ago.

So you would think that Obama and the Democratic leaders in Congress would begin to look for a "Plan B" to avoid the sort of political fiasco that could ensue, if they insist on passing a bill -- some bill, any bill -- regardless of the unintended consequences for health care and the possible public backlash against them.

The obvious Plan B is this: stop trying to fashion a single "comprehensive solution" to everything at once, and figure ways to solve pieces of the problem.

For whatever reason, we Americans are enamored of big, sweeping plans -- so much so that we scorn "piece meal" approaches to many problems and sneer at "patch work" answers to major challenges. But what if pieces and patches can actually gain wide, sustained public support and make real progress that delivers substantial benefits to large numbers of people without the risks of massive failure? It is hard to take that route after you've spent years saying that our health care system is "broken" and needs wholesale reform to keep us all from sinking with it. But such rhetoric is highly exaggerated: the "system" is not "broken;" most Americans have health care coverage and a large majority of them are happy with it; and we have for the most part quality care that extends and enhances our lives.

The problem is that about 15% of America's people do not have health care insurance at any given moment. Most of these folks are in one of these categories:

1) They have lost a job and their health care insurance with it.

2) They are young people who have passed the age when their parents' job-based insurance covers them but don't yet have -- or in some cases want -- coverage of their own.

3) They work for employers -- many of them small -- who do not offer health care insurance.

4) They are among the rapidly growing number of self-employed people, including those who work as temps or independent contractors.

Here's my suggestion: Why not start with a plan to address groups 1 and 2?

If you lose your job, you could be provided with stopgap coverage (say, through the existing Medicare program to avoid having to create new structures) for the period of time you're collecting unemployment compensation (unless you opt to exercise your Cobra rights, which people who can afford it might still do). Enacting this proposal in the midst of a recession in which there is 10% unemployment should be a breeze politically. And the fact that the stopgap is temporary would appease conservative sentiment. But millions of people would benefit concretely and right away.

What if you're one of the post-graduate young people who lose parents' coverage? This is actually an attractive group to insure, given that 20-somethings are generally healthy and unlikely to tap insurance funds a great deal. The problem is that private carriers have no easy way to aggregate them -- and only them -- into a group plan that makes sense for the carrier. It should not be rocket science for the feds to figure a way to encourage or require insurance companies to offer such plans for people within a specified (healthy) age range (and probably geographic area) who don't have access to other coverage. The cost of these plans could be held down further by offering what amounts to major illness coverage -- with low premiums but high deductibles. This step should be a piece of cake politically because it would not costs the taxpayers much, if anything.

OK, so that leaves the biggest group, number 3, and what may be the thorniest, number 4, uncovered. But it would be something accomplished this year, rather than nothing -- or what is becoming increasingly likely, a big mess.

What do you think? Post a comment.

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