Because I Can't Not Blog About Health Care Reform

Judging by the reactions of my Facebook friends and the people who leave comments on the blogs I read, people are pretty fired up about it. Some are fired up like the student section at a high school football game; and some are fired up like Peter Finch in Network. Here are my thoughts on some of the more interesting and controversial aspects of the legislation that the House passed late Sunday night:

• The Overwhelming Positives
  Insurance companies will not be allowed to deny or charge higher rates for customers because of pre-existing conditions. That's fantastic. They also will not be allowed to establish spending caps. Great. Insurance companies will be required to cover certain services, including preventative care. Very good. The plan also will create health insurance exchanges that will provide better and more affordable options for those who must buy health insurance on the open market. As someone who once had the misfortune of buying health insurance on the open market, I applaud this. These provisions alone make this legislation worthwhile.



• Abortion
  PolitiFact:
  
  

  The government won't pay for elective abortions. But under the Senate plan, people will be able to buy insurance that covers abortion on the new health insurance exchanges, as long as the insurance company pays for the services with patient premiums, not taxpayer subsidies. Medicaid has an exemption for cases of rape, incest, or the life of the mother.

  
  Even before the President agreed to sign an executive order saying that federal funds would not be used to cover abortions (the executive order that led to the bill's passing), the Senate bill already included measures to ensure that taxpayer money would pay for no abortion services (measures opposed by NARAL, NOW, and Planned Parenthood). Considering that abortion is a legal and tax-deductible medical procedure in the United States, abortion opponents should be pleased with the lengths to which both houses went to make sure that taxpayers will not be funding abortions.
  
  Also, a study in the New England Journal of Medicine found that "abortion rates declined during the first two years that Massachusetts implemented a near-universal health coverage program much like the [plan that the House passed on Sunday night]." So there's that.




• Medicaid Expansion
  I would guess that my state representative, Susan Lynn, and I agree on very little pertaining to health care reform. But I share Rep. Lynn's concern about Medicaid expansion. Medicaid is a joint federal-state program. Many states devote a big chunk of their budgets to Medicaid funding, and some (including Tennessee) are struggling to meet their current obligations. Paying for an expansion will be especially difficult for these states. While I think that Medicaid expansion is important, it could cause serious problems if relief is not provided to the states. On the other hand, this provision of the bill will not take effect until 2014; and a lot can change between now and then.



• Children Covered Until Age 26
  26 strikes me as too old to still be covered by one's parents' health insurance. Were I drafting such a provision, I would allow people to keep their parents' insurance for one year after completing or abandoning an undergraduate degree program or a trade school program, setting 26 as a maximum age. But I'm being picky here. Moving on . . . .




• The Individual "Mandate"
  My initial reaction to the provision that taxes individuals who do not acquire health insurance, either through an employer or through the forthcoming health insurance exchanges: I'm not crazy about it, but I understand its purpose. I really need to do more research on this topic before saying anything more.
  
  The President rejected the idea of an individual mandate during the 2008 primary campaign (and I favored his approach to Hillary Clinton's). He flip-flopped. But I don't mind when politicians flip-flop, if they're honest about it and have good reason for doing so. Often flip-flopping is preferable to stubbornly refusing to change one's mind. I respect President Obama for being up front about taking a new approach.



• This Is Nothing New
  Essentially, the health care portion of this legislation (as opposed to the student loan portion) does two things: 1) It regulates the health insurance industry. 2) It expands or modifies existing federal programs. The health insurance industry is by no means alone in being subject to federal regulation. The government already regulates agriculture, banking, tobacco, air travel, etc. And this bill does not create any new federal entitlement programs; it only adjusts programs that already exist.
  
  Contrary to many of the rumors and myths circulating about this legislation, it does not amount to government-run health care or a government takeover of the health care industry. The new American health care system bears very little resemblance to the health care systems in Canada or the UK. It is closer to the Swiss and German systems, but the plan passed by the House on Sunday is uniquely American. And, though this should be common knowledge by now, the bill does not create government panels that will decide what benefits or procedures individuals can receive (let alone the notorious "death panels" that will supposedly decide when to pull the plug on grandma).



• The Will of the People
  Polls showing that a majority or plurality of the American people were opposed to this legislation led some Republicans in Congress to make the case that passing this bill would amount to going against the will of the people. These representatives failed to consider that a significant minority of those opposed to the plan opposed it because it didn't go far enough. For many of these people, passing a flawed or incomplete bill was preferable to doing nothing at all. And I suspect that another significant minority of those opposed based their opinion (at least in part) on falsehoods about death panels and publicly funded abortions. (But I'm just guessing.) At any rate, according to a USA Today/Gallup poll released earlier this week, "By 49%-40%, those polled say it was "a good thing" rather than a bad one that Congress passed the bill." It's only one poll, but it should be enough to make one skeptical about claims that most of the American people did not want Congress to pass this health care reform package.