It’s funny what people complain about concerning health care reform. I see people people ridicule the Senate Finance Committee for producing a 1,500 page bill. Or complaining that Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi are combining the different versions of legislation passed in their respective chambers into consolidated bills behind “closed doors.”
Who cares how long the bill is? Much of the language is boilerplate anyway. The length of the bill reflects the complexity of the issue and the numerous sections of existing law that need to be changed. Complaining about the size of the bill is foolish and immaterial. It doesn’t matter how long a bill is. What matters is what it says.
As for private meetings among lawmakers to help shape the bill, what do people expect? Are Senator Reid and Speaker Pelosi supposed to have cameras trailing them as if they were stars of a reality TV show? As the Associated Press reports, these legislative leaders are determining what health care reform bill their caucus members can support and, if not, what changes are needed. These are not discussions best held among politicians playing to the media. And it’s not like the health care reform package is going to be passed in the dark of night when no one is watching. Already there have been weeks of public hearings, days of town hall meetings, and hours of press conferences. The legislation put forward by Senator Reid and Speaker Pelosi will be available online, dissected by bloggers, lawyers, and reporters from all political perspectives, and the subject of televised debates in Congress. Everyone will have more than enough opportunity to review – and to attack – whatever is put forward.
These frivolous attacks on the health care reform process are more an expression of frustration than a substantive problem with reform. That frustration stems from the reality that those making these charges are losing on the public policy issues. Seeing health care reform move in a direction they oppose, they are driven to throw every pebble they can find to slow down or derail the legislation. Ridiculing the Senate Finance Committee for generating a 1,500 bill may make them feel better in some way, but it doesn’t help their cause.
Many of the faulty ideas circulating around Washington today stem from a misunderstanding of health insurance and/or economics. These are the issues critics should be raising.
Issues like the need to balance a mandate on carriers to sell coverage to all applicants regardless of health conditions (“guarantee issue” with a requirement that all Americans purchase coverage (an “individual mandate.”) An imbalance between guarantee issue and an individual mandate will lead to disastrous results. The tough issue is making the balance affordable – a topic that is worthy of substantial discussion.
Another example: opinion leaders need educating concerning what drives health insurance premiums. Jonathan Alter is a bright man and his columns in Newsweek are usually well reasoned, even if his conclusions are controversial. Mr. Alter’s recent comments on health insurance premiums, however, reveals an unconscionable and surprising naiveté. “The key to a political victory on health care,” he writes, “isn’t just passing a bill, it’s controlling insurance premiums. After much-ballyhooed reform, Massachusetts failed to restrain premiums, which are set to increase another 10 percent next year. If the same thing happens nationally after Obama signs a bill, Americans will take it out on Democrats. So assuring that premiums don’t skyrocket should be the No. 1 priority as committee chairs get down to the short strokes.” Mr. Alter’s solution is a government-run health plan and/or caps on premiums.
If health insurance premiums were set arbitrarily, Mr. Alter’s suggestions might have merit. But health insurance premiums reflect medical trend. Here’s some uncomfortable facts (based upon this inflation calculator):
- It takes $1,820 in 2009 to buy what $1,000 purchased in 1989 after adjusting for retail price inflation.
- $1,000 in wages in 1989 have grown to $1,805 today based on wage inflation.
- However, it now takes $2,623 to pay for the same medical costs that $1,000 would have purchased twenty years ago.
The kind of public option being considered by Congress is not going to reduce medical costs. Only if a public plan can unilaterally impose reimbursement rates on medical providers will costs come down. Of course, if a government-run plan has the authority to set reimbursement rates there’s no future for private carriers. So if the public option is going to be designed in a way that eliminates private carriers, the logical solution is to skip the transition period and jump right into a completely government-insured system. Now that’s a weighty subject deserving attention and concern – a heck of a lot more concern than how lawmakers negotiate).
A cap on insurance premiums won’t directly effect medical costs either. (One might argue they could indirectly bend the cost curve if medical providers knew the carriers couldn’t pay more for their services, but caps are a messy way to achieve this speculative results). Premium caps – like any wage and price controls – are a feel good solution (who doesn’t like bashing insurance companies?) that accomplishes virtually nothing of substance.
Let’s face it, the insurance industry’s inept behavior (both politically and many of their business practices) make them a too easy target. Watching politicians and pundits bash insurance carriers is like watching high-tech hunters take down Bambi’s mom – it’s hardly a fair fight. It’s also immaterial to making America’s health care system work. If critics – and columnists – want to provide a meaningful public service, they should take a pass on the easy stuff (the number of pages in a bill or uninformed attacks on carriers) and raise tough issues like what it will take to address medical costs.
It’s harder to contribute to a debate than to snipe, but the time has come for heavy lifting.