Making a healthcare reform list and checking it twice
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The House has passed its version of healthcare reform and the Senate is debating another, hoping to pass it by the holidays. The different bills would need to be reconciled in a conference committee before going to the president’s desk.
As Congress heads toward the endgame, it is worthwhile to take a moment to look back at what were the goals when President Obama made the issue his top domestic priority.
Unlike Bill Clinton, Obama never offered his own detailed plan, leaving it to Congress to fight it out. But here is what Obama has said are the targets.
Universality: This would increase the availability of health insurance in all its forms, public and private, by mandating coverage, coupled with government subsidies. There are about 45 million people who lack insurance, though the numbers vary depending on the politics of who is doing the counting. Bills in both houses would increase coverage but not reach 100%.
Public option: The president has called for some mechanism to stimulate market competition with private insurance companies and to give consumers greater choice in picking a plan. Both aspects, competition and choice, are central in the administration’s hopes for changing the healthcare system. Proposals include a government-funded insurance plan, a national nonprofit plan, consumer-owner cooperatives and insurance exchanges that give price and service comparisons, as well as expanding Medicare and Medicaid. Obama has said he prefers a robust public option, but he is willing to take less if it increases competition and choice.
Deficit neutral: The final plan should not increase the federal deficit, Obama insists. That means a combination of new revenue and cuts in payments to providers. Some contend that those cuts mean less service, and others maintain that the cuts just eliminate waste, fraud and corruption.
‘Bend the cost curve’: The United States spends about 16% of its gross domestic product on healthcare, more per capita than any other nation. And the tab has continued to grow more than inflation and wages. Democrats and Republicans agree that cost is a drag on the economy and should come down.
Insurance reform: The private insurance industry also would face new regulations so that people would not be dropped because of previous medical conditions. Caps on benefits might be eliminated so that consumers wouldn’t face financial ruin as a result of a medical emergency.
Bipartisan politics: Obama has said he would prefer a bipartisan effort on healthcare reform, but also has insisted that the current system is not sustainable for the government, patients or healthcare providers. He has said he will not allow the Republican desire to hand him a political defeat to block change, but passing the final bill without some Republican support would be difficult and give the GOP an issue in the 2010 races and beyond.
-- Michael Muskal
twitter.com/LATimesmuskal
