Ezra Klein tells us what's at the core of health care reform:
But it's also worth offering a more general reality check here: The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt's plans, and reformers supported those. It was not in Bill Clinton's proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.
Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. That medical costs are one of the leading causes of bankruptcy in the United States. That an unemployed machinist gets screwed by fly-by-night insurance schemes while a comfortably employed banker need never worry. That the working class ends up in emergency rooms with crushing chest pains because they didn't have health insurance and didn't get prescribed cheap blood pressure medications five years before.
Klein's exactly right in saying that finding a way to insure the uninsured is the ultimate goal for health-care reform...in Congress.
So, in DC, we've got politicians figuring out how to insure the uninsured. Right now, it's essentially by subsidizing premiums for those that can't afford it. Unfortunately, most of those without insurance, and who want it, probably still wouldn't be able to buy insurance, even with subsidies. Most folks in that category have preexisting health conditions or are at or near poverty levels; no insurer would take them. So Congress is pushing a community rating - essentially prohibiting insurers to refuse to discriminate in pricing or coverage folks with preexisting medical conditions. Unfortunately instituting a community rating means that insurance premiums will go up - insurers will now have to pay claims for people who are sick. So Congress is pushing mandatory insurance, to compel those without insurance and who don't want it - the young and healthy - to buy it, thus having healthy folks essentially cover the costs of insuring the sick.
But is that what's really driving this latest push for health care? Is that what millions cheered for when Obama promised them health care reform? Health care for all? Or is there some deeper dissatisfaction - the denied claims, the high deductibles, the byzantine paperwork - behind the push, creating this dissonance between DC and the heartland over the issue? I'd argue yes. Americans hate the way they pay for their health care.
Basically I think Congress - and Ezra Klein? - has got the premise of health care reform all wrong. |
