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July 20th, 2009

More than most people, I’ve been following the health care debate very very closely.  Health care is not a new subject for me – in fact I should probably have a health care category.

The house is set to pass a health care bill fairly soon, but all eyes are on Max Baucus and the Senate Finance Committee. For months he has been working on a bipartisan bill that is budget neutral and can pass the Senate without the reconciliation tactic. He has even had some not-so-nice words for Obama in the past week.

Earlier in the week, the CBO issued a dagger of a statement to Congress, stating that current bills in the House will do more harm than good for the national health care deficit over the several decades. With medicare costs already threatening to bankrupt the nation, Congress must ensure that any bill that goes for a vote will convincingly budget neutral or better.

I am cautiously hopeful about health reform, especially since my employer-sponsored plan rose 25% this year! (It’s not even a Cadillac plan either, maybe a Honda.)

With that said, here are my biggest questions and concerns about health reform as I see it:

  1. Can Obama assure us that the U.S. will avoid long waiting lists and rationing that we see in other countries like Canada, France and the U.K.? By guaranteeing health coverage and providing subsidies for much of the population, health care demand will go up. On the other side of the fence, by enacting cost-controls for doctors and with the cuts already agreed to by hospitals, supply is sure to go down.  We’re already at a shortage for primary care physicians (only 2% of medical school graduates), and if millions more are added to the health care roles, what will the consequences be?
  2. Will U.S. tax dollars pay for millions to have access to abortion that is covered under the public option? The current version of the House reform bill includes this provision, which is even making some Democrats squirmy. Will the democrats fold under pressure to remove this provision? Last week, White House budget director Peter Orszag (already not a fan) was asked if “no taxpayer money will go to pay for abortions?” he replied, “I am not prepared to say explicitly that right now. It’s obviously a controversial issue, and it’s one of the questions that is playing out in this debate.”

    Currently, medicaid does not cover abortions, and most private insurance plans do not either. The White House is wanting the Secretary of Health & Human Services to be able to dictate an essential benefits package.

  3. Obama promised I could keep my current plan, but will I end up on the public plan eventually anyways?The biggest point of contention between Donkeys and Elephants right now is the so-called public option, or government health plan.  And no, it’s not what Congress and federal employees are already getting – they get a massive menu of private plan options from which to choose. Democrats believe the public plan is necessary in order to keep private insurers from ripping us off. Republicans think the private plan will have unfair advantages and suck millions of customers away from private insurance.

    To me, the public option will necessarily lead to single-payer health care down the road – I see no scenario where that isn’t the case. I’m not necessarily against single payer, though.  The other day I went into my CEO’s office and asked him straight up: “if there was a government health care option, would you continue to provide insurance to your employees, or just let us use the government plan and save the hassle?”  I would encourage you to ask similar questions to your employer.

  4. Is taxing the rich the best way to pay for health care reform?Current proposals by the House rely on a surtax on the richest Americans to pay for health care reform, but Baucus and many others are pushing to instead use a tax on health benefits that would affect far more citizens. There are two good arguments taxing benefits: First, it would generate much more income than the proposed surtax – likely 2-3 times as much. To this end, Congress would not have to rely on assumed savings which they are currently. Secondly, it brings money from the health care sector to pay for health care. This would encourage customers and unions to be more selective and consumer-like in the health care choices, and would tax those with very expensive health care plans.
  5. Are the savings figures just pie in the sky, or is it real money?Much has been made of the agreements and cost-cutting measures taken by the administration and different medical groups recently, and Democrats are counting on savings as much as income to pay for health care reform.  But can we trust that those savings will really appear down the road? What if they don’t? To me, this is similar to purchase a home with an ARM, anticipating interest rates to go down instead of up in the future.
  6. What are the unforeseen consequences that we should anticipate and plan for?Everything that Congress does has unintended consequences, and we need to look long and hard for those. Hope for the best, plan for the worst is a cliche that should be applied universally when drafting legislation.

    For example, last year congress enacted the Consumer Products Safety Improvement Act it put millions of children and teenagers at risk.

    Health reform will be the same way. State governors are already balking at the idea that the states will be required to pick up the tab for the proposed expansion of medicaid (states pay 43% of the medicaid bill). It is conceivable that state income taxes across the nation would rise in order to pay for this reform, and would surely affect those under the magic income level of $250, 000. This is just one example, but we need to expect there to be unintended consequences. So many times we draft legislation based on rosy assumptions (the current White House is notorious for this – look at their budget).

With all these questions, you might think I’m against reforming the health caresystem. No – I’m definitely for reform. The facts are undeniable – the U.S. spends way more for health care than other countries that are equally cared for, and millions who would like health care are without it. Further more, there are way too many unnecessary services being performed that just drive the cost up.

So, with the August recess quickly approaching for Congress, will the health care bill make the cut?  Post your thoughts below…

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