The problem: it has been reported (in the WSJ, of course, and elsewhere) that the Republican alternative won't raise taxes (at least, not on the rich); won't force individuals to purchase insurance or small businesses to cover their employees; won't include a public option to compete with private health plans; won't expand Medicaid or cut Medicare . . . so what exactly are they reforming? It sounds, to the untrained ear, like the Republican version of health care reform is status quo.
On the other extreme, Nancy Pelosi has upped the ante as both houses prepare to pass final versions of their internal bills prior to sending them to conference committee. I suspect that she has proposed her bill as a political maneuver, to give her more leverage when negotiating compromises with the conservative wing. But there are significant problems with Pelosi's proposal; specifically, it costs way too much (over $1 trillion); but it also pays for itself. That's a bad thing because it means a significant increase in taxes on the rich coupled with overly drastic cuts to Medicare in order to balance the budget on reform.
Not that I'm ever going to be in danger of paying the surtax, but a 5% burden added to folks already in the highest tax bracket is an overwhelming shock. I think a 1.5% to 2% surtax would be more palatable.
Pelosi is also in the camp that thinks Medicare is a generous payer, and that there is an abundance of fat to cut out of the system. I'm the first to agree that there is waste and economic profit in various pockets within Medicare, but I don't think there is overall excess. What needs to happen with Medicare is not overall cuts, but rebalancing of payments (e.g., the proposal to shift reimbursement to primary care physicians from specialists).
The System is Working (even if inefficiently)
Liberals and conservatives should take a short vacation from wallowing in fear and panic and take note that the system actually works! Yes, it's a good bit inefficient, and the pendulum swings could be a little less volatile. But overall, our system of government is actually working, with regard to health care reform. Different groups with different perspectives are pushing legislation that benefits them. These proposals are being whittled and reshaped through conflict with other parties who have other needs. After all the head butting and name calling is done, we'll have a final product that resembles what most of us want. Or at least will settle for.
And we'll know when we've arrived at a suitable compromise, because the fringes on either side of the middle will be screaming about the injustice and irresponsibility of final bill. Beware a final bill that is blessed by either the far right or the far left!
Illegals seeking wellness
I should save this for another column, because (1) this one is getting too long; and (2) this is a whole 'nother subject. But I can't let this issue pass without comment. The issue: some conservative Democrats and (do I even need to say it?) most Republicans are concerned that undocumented workers will be able to purchase insurance from the Public Option (even though they are barred from receiving government subsidies).
These congresspersons want to prohibit these "aliens" from purchasing Public Option coverage. Are they crazy? Why would we NOT allow them to PURCHASE insurance? Who cares if it's a government-managed plan, if these undocumented immigrants are paying in full for the coverage? At least, then, when they seek medical attention, it will be paid for with privately paid premiums, rather than tax dollars.
If we refuse to allow these immigrants to purchase insurance, based on some misguided jingoistic principle, when they do require urgent medical care, as eventually some will (remember, many of them do the jobs that are too dangerous, or low paying, or back-breaking, for red-blooded Americans to perform), these undocumented workers will show up in the already strained emergency rooms of our hospitals, and we will treat them, because federal law requires that we treat them (EMTALA . . . we can't turn away true emergencies, regardless of any circumstances, including citizenship and ability to pay). And, because we didn't allow them to purchase insurance, YOU will pay for their care, with your tax dollars (Emergency Medical Assistance, or EMA Medicaid), or with higher prices and higher insurance premiums (cost-shifting by providers to cover uncompensated care).
Not only as a matter of fairness, but also economic common sense, we should enthusiastically allow undocumented aliens to purchase the Public Option plan. If it's a matter of nationalistic principle, then deport them all and "Hire American!" to build houses and buss tables. But if we're going to exploit their work ethic, the least we can do is allow them the opportunity to be healthy.
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