Obamacare: Seven Bad Ideas for Health Care Reform
Tanner, Michael, USA TODAY
PRES. BARACK OBAMA has made lit clear that reforming the American health care system will be one of his top priorities. In response, congressional leaders have promised to introduce legislation before summer's end, and they hope for an initial vote in the Senate prior to the Labor Day recess.
While the Administration has not, and does not seem likely to, put forward a specific reform plan, it is possible to discern the key components of any plan likely to emerge from Congress:
* At a time of rising unemployment, the government would raise the cost of hiring workers by requiring employers to provide health insurance to their employees or pay a fee (tax) to subsidize government coverage.
* Every American would be required to buy an insurance policy that meets certain government requirements. Even individuals who currently are insured--and happy with their insurance-will have to switch to a plan that meets the government's definition of "acceptable insurance."
* A government-ran plan similar to Medicare would be set up in competition with private insurance, with people able to choose either private insurance or the taxpayer-subsidized public plan. Subsidies and cost-shifting would encourage Americans to shift to the government plan.
* The government would undertake comparative-effectiveness research and cost-effectiveness research, and use the results to impose practice guidelines on providers--at least initially, in government programs such as Medicare and Medicaid. Eventually, though, those guidelines likely would become mandates extending to private insurance plans, resulting in more rationing of the nation's medical care.
* Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk.
* Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded.
* Finally, the government would subsidize and manage the development of a national system of electronic medical records.
Taken individually, each of these proposals would be a bad idea. Taken collectively, they dramatically transform the American health care system in a way that would harm taxpayers, health care providers, and--most importantly--the quality and range of care given to patients.
Administration officials repeatedly have referred to health care reform as Pres. Obama's "top fiscal priority" and called the need to restrain the growth in health care costs "the single most important thing we can do to improve the long-term fiscal health of our nation." In his first address to Congress, the President declared, "Health care reform cannot wait, it must not wait, and it will not wait another year." At a February 2009 White House Summit on health care reform that included many of the congressional and industry stakeholders, Pres. Obama insisted that health care reform must be passed "this year." Obama's proposed 2009 budget included $634,000,000,000 as a "down payment" for health care reform, although it contains no details about how that money would be spent.
The President apparently does not plan to put forward a specific plan for reform. Rather, the Administration is offering general guidance and direction, while leaving the details up to Congress. This strategy stems from the belief of many Administration analysts that one reason for the failure of Pres. Bill Clinton's attempt at health care reform was that his Administration developed a specific plan in secret, without congressional input, then attempted to force Congress to accept it.
Still, it is possible to discern the outlines of what a health cam reform proposal acceptable to the White House will look like. Pres. Obama outlined his ideas in considerable detail during the campaign. …