Health Insurance Reform Must Begin Now But Should Be Incremental:Baucus Plan A Possible First Step
President-Elect Barack Obama indicated that addressing the health insurance would be his third priority but seeing the relationship to the cost of health care to the cost of employee to business may mean that he needs to move it higher up the priority tree. Although everyone can agree that poor planning and unrealistic expectations contributed to the out of control health care costs at General Motors, the truth is that for all employers even those that are nonunionized the current cost of maintaining health insurance for employees is unsustainable.
Business needs to be able to determine what are the costs of a job in order to make plans. The current environment creates a situation where the average business may be seeing increases in health care costs of about 40% per year. Regardless of how good the productivity of the worker or the company this cost alone may eventually be the major factor in determining our levels of employment especially for those low wage earners with little skills. We cannot stabilize our economy or our level of joblessness unless we begin to work on health care reform now.
Senate Finance Chairman Max Baucus (D-MT) has released his thoughts in A Call to Action:Health Reform 2009. This plan would create a national health care insurance exchange where private insurance companies would compete with a basic government sponsored health insurance plan either of which would be employer based. For those aged 55 to 64 there is the possibility that they could enroll in Medicare. Higher income wage earners who receive employer based benefits would be taxed for their health insurance benefits to help subsidize lower wage earners. Government programs for the poor, disabled, and children would be strengthened. Insurance coverage would be mandated for all Americans.
Health care is so complex and has so many lobbying interests including pharmaceutical companies, hospitals, doctors, health insurance companies, and unions to name a few that it seems almost insurmountable. Already the plan this week has been attacked by conservative and liberal think tanks as quite flawed however many did say it was a useful starting point and in that was an important work. The plan does address a major problem, that vulnerable group of the population who often are working but can not get insurance unless it is employer based, the 55 to 64 year olds ability to get insurance.
The most significant question for the future of health care in America is whether there can ever be a totally private program supported by government regulation and tax policies or will it be always necessary to have a significant government programs such as Medicare, Medicaid, and CHIP to cover those not covered by private programs. Making health insurance employer based will likely make the additional existence of a government sponsored program for those not employed like elders, the disabled, the unemployed, the chronically ill, and the mentally ill always necessary. On the other hand, if we make a consumer based health insurance program that is not specifically employer based then perhaps in the long run a simpler system that would equalize things for the employed and the unemployed might be possible.
The goal of the Baucus programs is to maintain health care costs at the current levels by cutting waste, prioritizing primary care and prevention, setting standards for efficiency, and improving information systems. These are worthwhile endeavors, however, whatever we do the future will likely see increasing health care costs due to the aging of the population and the continued development of medical science. Efficiency is important but realistically maintaining a high level of health care for the future will ultimately require that we drastically improve the productivity of the average American worker. If the overall productivity of the economy cannot be increased than no matter how efficient the health care system there will come a point beyond which further expenditures are not tenable and health care priorities will need to be triaged. For example, already many European countries already are limiting care to the extremely elderly in such things as heart disease.
America has to come to terms that there may be limits in a what our health care system can accomplish but also because of that we have to demand that there is a system that is fair to all and with the least waste possible. The Baucus proposal is not perfect but it does bring up many important issues.
Those who wish to abandon government programs now or avoid a national system have to do the leg work to come up with proposals that will deal with both the unemployed, the employed, children and the elderly. A totally private system that is supported by tax policy and regulation such as the Federal Employees Health Benefits Program (FEHBP) which could be adopted as a nationwide program has been advocated by the Heritage Foundation and others. In the long run this would be a better single system of competing private insurers for all Americans and not requiring a government insurance plan for any. If Republicans and other conservatives wish to gain the necessary consensus then they must come up with realistic action plan to implement this program.
Senator Baucus rightly has stated that his plan would take years to finalize and would require a monumental effort to implement. An argument against massive total reform is that it may be so hard to accomplish and take so long that discussing it is useless. Perhaps the best way to look at meaningful health reform is to do it a step at a time. If we prioritize dealing with insurance for the employed right now and stabilize our government programs than perhaps that will buy us time in the future. We cannot wait three to five years to reform health insurance for the employed because the level of uninsured may swell to above 50% nationwide. Incremental change in the health care system, a step at a time, may be easier than jumping into the unknown.
Tony Barclay is a retired physician and graduate of Harvard Medical School.
Go To Contempo Magazine Home Page
