Let's hope Congress can focus on health care after the election
Steve JacobPrior to each national party convention, I examined health plans of presidential candidates Barack Obama and John McCain. Both appear to be long on wishful thinking in terms of cost savings and vague on the ultimate price tag. And both appear to be a collection of goals, rather than rising to the level of coherent plans.
Obama counts on dubious savings from electronic medical records, prevention programs and chronic-disease management to pay for universal coverage for children and subsidies sufficient to make premiums affordable for all.
McCain counts on market forces to lower costs by providing tax incentives for individuals to buy their own health insurance rather than rely on their employers. He woefully underestimates the cost of subsidizing the coverage of those with chronic conditions who inevitably would be turned down by insurance companies.
Each candidate's supporters challenged me to come up with something better.
Actually, that's not necessary.
Several interesting health-care plans have been introduced in Congress. Most lack publicity because their co-sponsors are not running for president. And there are bound to be several more after the election.
Sen. Edward Kennedy, D-Mass., apparently plans to offer his own plan. He has long been a champion of universal health care and feels a sense of urgency and perhaps seeks a legacy, given his uncertain future in the wake of brain-cancer surgery.
After the election, the plan championed by the new president will just be one more in the legislative hopper.
The will of the American people seems pretty clear. According to a 2007 CBS News/New York Times poll, 90 percent say the health-care system needs fundamental change and more than one-third favor a complete overhaul. Two-thirds said the federal government should guarantee health insurance for everyone, and that it was even more important than controlling health-care costs. The trick is doing so without breaking the bank.
One plan in Congress appears particularly promising, although others may emerge next year.
The Healthy Americans Act (HAA), introduced in early 2007 by Sen. Ron Wyden, D-Ore., and Sen. Robert Bennett, R-Utah, is co-sponsored by eight Republicans and eight Democrats.
HAA would achieve McCain's goal of replacing employer-based health insurance _ as well as Medicaid and the State Children's Health Insurance Program.
All Americans would be required to buy coverage through state or regional purchasing pools. Instead of paying the insurance companies directly, the premiums would be collected along with federal income taxes, minus a fixed deduction. Low-income households' premiums would be subsidized. Businesses and state governments would no longer be funding coverage directly, but they would be making much more modest annual contributions to the system.
The HAA appears to achieve many important goals:
FINANCIALLY SELF-SUPPORTING. A joint analysis by the Congressional Budget Office and Joint Tax Committee called the plan "budget neutral" when fully implemented and said it may actually produce future surpluses.
SHARED RESPONSIBILITY. Everyone has skin in the game _ individuals, employers, state and federal government.
UNIVERSAL ACCESS. The individually mandated health insurance ensures there would be no freeloaders. And the nation would be stronger economically. The Institute of Medicine estimates the uninsured lose $65 billion to $130 billion annually because of poorer health and shorter life span.
COST EFFICIENCY. Broad insurance risk pooling and large-scale negotiation of pharmaceutical prices would reap significant administrative savings.
EQUITABLE RISK POOLING. The distribution of health risks among large populations would protect those with chronic disease.
ENHANCED COMPETITIVENESS FOR U.S. BUSINESSES. According to a New America Foundation study, U.S. companies paid $2.38 per hour for health insurance for workers earning $18 an hour in 2005. Companies in Canada, Japan, the United Kingdom, France and Germany spent $0.96 an hour for workers earning $20 an hour. Health-care costs have been an albatross to American businesses. The HAA would virtually eliminate that.
I also find the plan personally attractive. Under the HAA, I am more likely to get a bigger raise. One of the key reasons for stagnant wages in recent years is that health-care hyper-inflation is crowding out potential increases. Employers have much more discretion over employee salaries than the cost of insurance premiums.
I am 56. If I lost my job, I would pay a handsome sum for comparable health insurance if I could not find work with similar benefits or decide to work for myself. Under the HAA, health insurance is portable and costs the same regardless of employment status.
HAA strongly resembles the health-care system in the Netherlands.
Mentioning of Europe and universal coverage often causes eyes to roll and minds to snap shut. But the Dutch model is government-facilitated, rather than government-run, as in Canada and Great Britain. Individual responsibility and private insurance are deeply rooted in both the U.S. and Dutch cultures.
The AmeriCare Health Act of 2006, introduced by Rep. Pete Stark, D-Calif., is similar to HAA in most respects. But it would use Medicare as the primary coverage vehicle rather than private insurance.
Health care deserves center-stage congressional examination in 2009. Let's hope partisan gridlock and self-serving lobbyists don't derail debate on what appear to be promising solutions.
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ABOUT THE WRITER
Steve Jacob is publisher of the Star-Telegram/Arlington and Northeast Tarrant County and a master's student in health policy and management at the University of North Texas Health Science Center in Fort Worth. Readers may write to him at: 400 W. 7th Street, Fort Worth, Texas 76102, or via e-mail at sjacob@star-telegram.com.
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