Wednesday, March 24, 2010

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

    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.


Anonymous RyanD said...

I'm glad you decided to blog on healthcare reform. Thanks for the insight... and for having the courage to share it. Good thoughts.

7:53 AM  
Blogger Mary @ The Writer's Block said...

Very good, Josh. Very good. I like the way you think! (Ever considered running for office? :) )

On the abortion issue: I had actually thought about the fact that with this reform in place, abortion rates may actually drop due to more preventive care AND a sentiment that "well, I can take care of my baby because I'll have healthcare for it." That was just a thought I had, so I appreciate your addressing that point.

Now, another thing I'm hearing, though, is that even with this executive order and Hyde amendment, etc., unless legislation specifically spells out that money is NOT to be used for abortions, it still can be. That is why abortion opponents are not at all jazzed by the executive order and are mad at Stupak and say this is the worse day since Roe v. Wade.

I don't know. I haven't researched it, but that's what they are saying.

Have you heard anything like that? I have no idea what is truth and what is "spin" anymore.

7:56 AM  
Anonymous Anonymous said...

That as a well written blog. Thanks, I actually understand something about the bill.

Regarding mandatory insurance, here in IL we are required to have car insurance to get a drivers license. You have to bring proof and if you don't - no license.

I wonder if Ray Lahood, who was our Rep in my part of IL, wasn't the Sec of Transportation - if he really would have supported it.

Phil G

10:08 AM  
Blogger Matt Wittlief said...

Good summary, Josh. Always appreciate having your thoughts. I'll add a few of my own.

I agree with you that the debate and rhetoric is WAY-overheated - especially by the GOP. But, the Dems are also off base, in my opinion, in trumpeting the glories of this bill. It will do nothing to materially manage costs and reinforces the existing system which is VERY flawed (and, yes, uniquely American).

Overall, I'm not really a fan of the legislation. I find the individual mandate very troubling whether you can make a roundabout Constitutional case for it or not. That would only be based on poor precedents which have already been set and upheld. This is different than mandating car insurance (not everyone has to have a car, state vs. federal) and further serves to line the pockets of the health insurance industry.

We need true reform to the system. Despite anything that the CBO has published, this will end of costing the federal government more money. And health care is already way too expensive and unsustainable. Our politicians have kicked the can again - which is one thing they are good at.

6:59 PM  
Blogger Tinley said...


Re: the mandate. My understanding is that it isn't so much a mandate/penalty as it is a tax/tax break. As I understand it (and I could be wrong), Congress has imposed an insurance tax; anyone who has insurance would get a W2-esque form that would exempt him or her from the tax. Practically there's really no difference between a mandate/penalty and a tax/tax rebate, but structuring it as such makes it constitutional. (Again, I could be mis-understanding some of this.)

I also have some concern about the cost, but I'm still trying to get a better handle on the CBO numbers and a clearer sense of the long-term price tag.

8:35 PM  

Post a Comment

<< Home