Editorial series: Rehabilitating Healthcare

November 16, 2009

REHABILITATING HEALTHCARE

One nation, insured

As healthcare reform legislation advances in Congress, more state lawmakers are looking for ways to limit its effects on their constituents. At the front of the pack is the Arizona Legislature, which agreed to put a constitutional amendment on next year's ballot that would provide three new rights to its citizenry: to obtain coverage from a private insurer, to buy healthcare services with their own funds directly from doctors and hospitals, and to be free not not to buy insurance or participate in a particular healthcare plan. That last right would run counter to the comprehensive reform bills moving through Congress, which would require everyone to obtain at least a minimum level of coverage -- with subsidies, if necessary. Spurred by a conservative advocacy group called the American Legislative Exchange Council, lawmakers in nearly 20 other states have either introduced or announced plans to introduce proposals similar to Arizona's "healthcare freedom act."

November 9, 2009

Editorial

Healthcare's hurdles

The House passed a sweeping healthcare reform bill Saturday despite the opposition of as well as 39 mainly centrist Democrats. This illustrates both the success and the failure of the Obama administration and House Democratic leaders on this issue. On the one hand, they've sold lawmakers in both parties on the need to rein in rising healthcare costs. But on the other, a significant minority on Capitol Hill -- and a sizable portion of the public -- don't see the connection between controlling costs and extending affordable insurance to all Americans.

4:33 PM PST, November 5, 2009

REHABILITATING HEALTHCARE

Immigration and abortion: two hot buttons

Senate and House bills limit coverage for illegal immigrants and abortion. But critics aren't satisfied.

October 24, 2009

REHABILITATING HEALTHCARE

Righting wrongful denials of insurance coverage

One purpose of the healthcare reform effort in Washington is to help more Americans obtain coverage, in part by making policies available to people with preexisting conditions. But the pending bills wouldn't end the nightmares faced by others whose insurance fails them when they need it most.

October 4, 2009

REHABILITATING HEALTHCARE

The surgery begins

The Senate Finance Committee put the final touches on its healthcare bill early Friday morning, and soon Democratic leaders will begin reconciling it with a more costly alternative approved by the Senate's health panel. When they're done, they'll face the toughest test yet for advocates of comprehensive reform: getting past a Republican filibuster on the Senate floor. Majority Leader Harry Reid (D-Nev.) has threatened to invoke a procedure typically reserved for budget-related bills to allow healthcare legislation to advance with a simple majority, not the 60 votes required to end a filibuster. But 60 is the right threshold for this far-reaching measure because it would force sponsors to build a broader consensus, particularly on three core issues now dividing liberals and moderates: how much to subsidize policies for the uninsured, how to pay for the subsidies and how to promote competition among insurers.

September 18, 2009

REHABILITATING HEALTHCARE

The heart of the matter

After weeks of talks with a small group of Republicans, Senate Finance Committee Chairman Max Baucus (D-Mont.) released his long-awaited healthcare reform proposal Wednesday with no GOP co-sponsors -- all but eliminating the chance for significant bipartisan support. Baucus' quest was quixotic, especially with leading Republicans denouncing anything that remotely resembles "Obama-care." It also weakened his support among Democrats on his committee, some of whom have already criticized the proposal. Nevertheless, the bill represents an important step forward. Even without Republicans on board, it shifts the debate to the right on several issues at the heart of the reform effort, including how much taxpayers and businesses will pay to help the uninsured buy coverage. That shift presents a chance to bring the public's focus back to the flaws in the current system and the challenges posed by any attempt to fix them.

September 10, 2009

REHABILITATING HEALTHCARE

Dollars and sense

President Obama took care of the easy tasks Wednesday in his much-anticipated speech to Congress on healthcare reform. He laid out the main provisions he's looking for in a comprehensive bill, and provided a clear and powerful rationale for fundamental change. But the steps he endorsed -- including new regulations on insurers and help for the uninsured to obtain coverage -- already have broad support from industry lobbyists and lawmakers. The hard part, in terms of both policy and politics, is finding a way to pay for the expansion in coverage. And on that most contentious issue, unfortunately, Obama argued that Congress could cover most of the cost by attacking waste, fraud and abuse in Medicare and Medicaid -- a pain-free path that's as unrealistic as it is alluring.

September 8, 2009

REHABILITATING HEALTHCARE

President Obama must refocus the debate

In a make-or-break speech Wednesday on healthcare reform, President Obama is expected to give Congress more details on how he wants to expand coverage, control costs and improve quality. He's late to the game -- possibly too late. The healthcare debate thus far has been more about politics than policy, with liberals bashing insurance companies and conservatives decrying intrusive government. The president needs to put the focus where it belongs: on the problems in the healthcare system and how to fix them. Doing so, however, will require him to add particulars to the principles he has laid out for "Obama-care."

September 4, 2009

REHABILITATING HEALTHCARE

Healthcare reform bill doesn't cover elective abortions

Since the Supreme Court's ruling in Roe vs. Wade, every federal health insurance program has become enmeshed in the debate over federal funding for abortion. This year's efforts to reform the healthcare system have triggered a new tussle, with opponents of abortion claiming that the proposals would change the long-standing policy against using federal tax dollars to terminate pregnancies. But the provision that antiabortion groups find so objectionable would actually have the opposite effect, forcing private insurers to go further to fund and account for abortion coverage separately from federally subsidized services.

September 2, 2009

REHABILITATING HEALTHCARE

Patient approach

August was a tough month for supporters of healthcare reform. Instead of pushing a comprehensive bill close to passage by the time Congress adjourned for its summer break, they were still struggling to get to a vote in the House and a key Senate committee. The news media were filled with reports of protesters howling that "Obama-care" would socialize medicine, promote abortion and ration care for seniors. Polls showed support for the reform effort dropping steadily. The month ended with the death of Sen. Edward M. Kennedy, the advocate historically most effective at striking the compromises necessary to get a bill signed.

August 24, 2009

REHABILITATING HEALTHCARE

Doing nothing is not an option

If costs keep growing at their current rate, healthcare will consume 20% of all spending in the U.S. by 2018. Nevertheless, critics of "Obama-care" argue that the country can't afford the reform bills moving through Congress. They claim the added costs imposed by the reform would lead inexorably to painful cuts in existing federal health programs, particularly Medicare. These concerns aren't unreasonable, considering the pressure that the enormous federal deficit will put on government services. But the better question is what might happen to Medicare if the healthcare system isn't isn't reformed.

August 17, 2009

REHABILITATING HEALTHCARE

Illegal immigrants debate could potentially block reform

Opponents of healthcare reform argue that Congress would give illegal immigrants health insurance at taxpayer expense. The claim stirs a lot of resentment, particularly in border states struggling to cover the costs that undocumented immigrants impose on hospitals, schools and other public services. And although there may be valid reasons to improve the healthcare services these immigrants receive, it's a step lawmakers can't take without jeopardizing the reform effort as a whole.

August 13, 2009

REHABILITATING HEALTHCARE

The sick status quo

Cable news channels have devoted hours of airtime this week to the rancorous debates about healthcare reform at town halls across the country, supplementing the coverage with alarmist commercials about rationing and government-run care. Notably, opponents of the reform effort haven't tried to defend the status quo. Instead, they've spent their time painting exaggerated pictures of what the system might look like in the future -- a world of "death panels,” delayed treatments and lethal cost-cutting. In short, their nightmarish depiction of "Obama-care" looks a lot like a Hollywood version of an HMO, but with seniors instead of starlets.

August 9, 2009

REHABILITATING HEALTHCARE

Make the case for healthcare -- now

After Congress adjourned for its annual August recess, many lawmakers were welcomed home by boisterous protests from opponents of healthcare reform. There's more than a whiff of ersatz outrage -- the backlash apparently has been orchestrated by GOP partisans who think that blocking the overhaul will help them derail the rest of President Obama’s agenda. Nevertheless, the protesters' ability to overrun town meetings reflects how small a stake most attendees feel they have in the reform effort and how skeptical people are about the need for fundamental changes to the way healthcare is provided and financed.

July 20, 2009

REHABILITATING HEALTHCARE

The reality of rationing

Opponents of the main Democratic proposals for healthcare reform warn that consumers would be stopped from getting the care they need when they need it. President Obama's plan is "rationing," one political strategist blogged. It's an unrealistic criticism, yet policymakers shouldn't sugarcoat reality: Rationing is part of the healthcare system today, as it will be under any overhaul fashioned by Washington. That's no argument for sticking with the current approach, however. Without significant improvements in the way healthcare is delivered and paid for, the escalating costs will cut off more people from the care they need.

July 16, 2009

REHABILITATING HEALTHCARE

Spread the pain of paying for healthcare reform

Lawmakers have pushed their efforts to overhaul the U.S. healthcare system into a higher gear, with a Senate panel approving one Democratic proposal and a House committee starting to debate another. The 1,018-page House bill (HR 3200), which the Democratic chairmen of three committees introduced Tuesday, is a decidedly mixed bag, reflecting the difficulty of making large-scale repairs while preserving the healthcare options people have today. The measure would make some important changes in the way healthcare is delivered and financed, yet it falls short of some goals and overshoots others.

July 13, 2009

REHABILITATING HEALTHCARE

Improve care, lower costs

Americans like to complain about the healthcare system, but they're unnerved by many of the proposals for improving it. More than 90% of those surveyed last fall by the Deloitte Center for Health Solutions said that healthcare costs are a threat to their personal financial security, and 80% gave the system a mediocre grade or worse. Yet less than half favored measures to promote electronic medical records, the use of scientifically proven treatments or more monitoring of the safety and effectiveness of drugs. Evidently, we'd rather live with the shortcomings we know about than risk more severe ones.

July 6, 2009

REHABILITATING HEALTHCARE

Covering the uninsured: A cost that pays

Access to affordable healthcare in the United States is an entitlement, a perquisite or a fantasy, depending on a seemingly arbitrary matrix of factors. Government insurance programs are available for the elderly, the permanently disabled, people with failing kidneys, the impoverished and children from low-income families. But how poor one has to be to qualify varies from state to state and from year to year. Employees at most large companies and many small ones can take advantage of group insurance plans negotiated by their employers. But millions of people who work in low-paying service, retail or contracting jobs have to seek individual insurance policies, which may be unaffordable or unavailable because of their medical histories. Others obtain insurance with deductibles so high or coverage limits so low that one bad accident or illness could bankrupt them.

June 29, 2009

REHABILITATING HEALTHCARE

Focus on results, not treatments

Alarmed by increases in healthcare costs, policymakers and insurers have adopted a series of reforms over the years -- such as price controls and HMOs -- whose savings proved to be temporary at best. With that history in mind, some experts say that the only sure way to control the growth in healthcare spending is for the government to cap it, a cure that would be worse than the disease. There may be no quick fix, but there certainly are ways to deliver and pay for healthcare that can give consumers more value for their money. If we undertake them now, the eventual result will be a higher-quality system that's more sustainable and affordable.

June 22, 2009

REHABILITATING HEALTHCARE

Diagnosing the problem

Legislation to overhaul the U.S. healthcare system hasn't emerged from congressional committees, yet it has gained enough momentum for the demonization of the reform effort to start in earnest. For example, Republican strategist Karl Rove called it "President Barack Obama's government-run monstrosity" in an Op-Ed article Thursday in the Wall Street Journal. Other Republicans, hewing to the rhetorical line drawn by consultant Frank Luntz, warn of a trillion-dollar "government takeover" of the healthcare system a la General Motors or American International Group.