Barack Tells Congress To Get Off Their Pork-Filled Butts

Barack Obama is apparently not happy with the progress, or lack thereof, that his Legislative Glee Club is making on putting together a health care reform proposal. So, in true “Yes, we can!” form, he has decided to roll up his sleeves and write the thing himself. Well, when he gets back from France anyway.

According to the Associated Press: “The White House, backing away from President Barack Obama’s ‘it’s-all-on-the-table’ approach initially advocated, prepared to get louder and more involved in the details of a health care overhaul that officials once were content to leave to Congress, administration officials said Saturday.”

This certainly explains why Obama has backed off on his campaign promise not to tax health care benefits. Remember when he blasted John McCain for even suggesting that taxing employer paid health coverage payments was a viable option? I think his comment was something to the effect that the last thing the American worker needed was increased taxes.  In the interest of getting some form of reform through before what’s left of his political capital washes away in a sea of spending, he’s leaving all the options open.

So, for those who haven’t been keeping up, let’s see where the health care debate is right now. It’s important to understand the plan options that are being thrown around, especially since the President is bound and determined to have a plan finalized and approved by the end of the year. This means he will need to get something rolling on Capitol Hill before Congress goes off to Summer camp.

To review the issues:

Health care costs: Wayyy too high
Health care quality: Wayyy too low
Americans without health care: 46,000,000
Estimated cost to expand health care coverage to include them: $1.2 trillion greenbacks (over a ten year period)

Do we need reform?  Definitely.  I think most people on both sides of the political fence would agree that our health care system is bloated and broken.  The debate rages around the measures that need to be taken to fix it.

The two primary points of contention?

One, should health care coverage be mandatory for all Americans? Why make insurance coverage mandatory?  Why should I care if you have insurance coverage or not?  Because if you don’t have coverage and get hospitalized, you may not be able to pay your medical costs.  You will default on them and they will be passed on to me in the form of taxes and/or an increase in my medical coverage premiums.  So coverage for all reduces costs for all.

Obama was against this during the campaign.  It was a Hillary rallying cry that Barack opposed in favor of a more incremental approach where coverage would first be mandatory for children only.  I believe his opposition was more of a pragmatic “there’s no way we could make this happen immediately” than a disagreement over an ultimate goal.

Well, now he appears to be open to this requirement, which is being promoted by Democratics and some Republicans in both sides of the house, being made a part of the initial bill.  Again remember, goal number one for Obama is to get a health care reform bill passed this year.  Therefore, compromise where necessary.  He does mandate that a “hardship” exclusion be a part of the bill which would exempt certain people unable to afford the cost of coverage.  What constitutes a “hardship” is an open question.

The trick is that to make health care coverage mandatory, alot of work will have to be done to clean up the existing medical system to reduce the waste and inefficencies that have resulted in the upward spiral in treatment costs.  Reduce treatment costs and presumably you reduce the cost of providing coverage for them.

There also would need to be a clear understanding of what mandatory coverage includes?  Presumably some baseline for the minimum accepted coverage levels would be defined.  But again, until there is reform in the medical treatment system that reduces waste and costs, trying to enforce mandatory coverage is putting the cart before the horse.

The other main point of contention in the battle to put a health care reform bill together is whether the bill should include the formation of a government-run public insurer agency.  This agency would serve to, theoretically, provide a low-cost alternative to the private insurance that is typically subsidized by employers.  This would not be a totally new role for the government, as it already does such a *great* job running Medicare and Medicaid.

There are obvious reasons why most Republicans and many of the moderate Democrats are against this.  It’s anti-business.  A government managed health insurer would have the leverage to force doctors, hospitals, big pharma, and other players in the game of medicine, to cut costs.  A good thing, right?  Usually.

But what has happened with Medicare, is that all the government cost cutting has led to a significant reduction in the quality of medical care for those who are covered.

The health insurance industry, with the backing of the pharm companies, is lobbying really hard against the formation of a government-run public insurer agency.  This is purely in their best interest.  They don’t want to be in competition with the government.  From a cost standpoint, it’s a war they will not win.  Not when the government can strong arm the medical field into cutting costs and even subsidize coverage costs with taxes.  Definitely an unlevel playing field.

Health insurers are fighting back.  They state that “a public plan won’t be needed if reformers successfully expand coverage to the uninsured through mandated insurance and guaranteed issuance of policies, find ways to control medical costs, prohibit exclusions for pre-existing conditions, and provide subsidies to help people afford coverage.”

So, it would appear that due to Obama’s pushing, health care reform is coming.   At this point it really seems to boil down to a race between the existing insurer industry and the government to create a proposal that is palatable to the populace.

I really have little faith that the insurers can band together and create a package that will force them to clean up their own act by reducing costs, expand coverage to the uninsured, and upgrade the quality of care provided.  Especially when they’re up against a current administration and Congress that has shown a willingness, and even an enthusiasm, for throwing buckets and buckets of money at a problem.

We’ll get a public health insurance agency of some type.  And we’ll be paying through the nose for it.

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