Flaws will need to be fixed
Published 4:29 pm Monday, March 22, 2010
When President Obama signs the historic health-care overhaul bill into law, it will mark only the first serious step toward fixing a dysfunctional system. Much more action will be needed in the coming years to transform the nation’s health-care system into one that’s fair, cost-effective and sustainable.
After years of inaction, it’s a major step forward that 32 million of the nation’s uninsured will be covered. Health care is closer than it has ever been to being a right in America, a welcome value statement. And Americans with insurance will no longer face losing their coverage if they get sick or lose their job.
But such gains require tradeoffs, which this legislation may not address adequately. Fixes will be needed.
Some will come immediately. Aspects of the bill that passed the House on Sunday are the product of legislative sausage-making at its worst — like the infamous “Cornhusker kickback” that gave Nebraska extra Medicaid funding in return for a crucial Senate vote. Such provisions are expected to be eliminated when the Senate approves changes passed Sunday by the House.
Time will likely expose more substantive flaws. For example, many of the positive insurance reforms — like no exclusions for pre-existing conditions and no cancellation of existing policies because of illness — would clearly push premiums higher if more healthy people don’t join the insurance pool. Insurance works by spreading risk among a wide population. That’s why the bill requires everyone to have health insurance.
It’s unclear whether penalties in the bill for failing to buy coverage are strong enough to be effective. To keep premiums affordable for all, this will have to be tracked closely, and penalties stiffened if too many people ignore the new mandate. Efforts by some Republican state attorneys general, including Washington’s Rob McKenna, to overturn the mandate in court are profoundly unhelpful.
Paying for the bill will also be an ongoing issue. Yes, the Congressional Budget Office says it will cut the federal budget deficit by $143 billion over 10 years, but that’s misleading. It doesn’t take into account pending reductions in what Medicare pays doctors, cuts that Congress routinely overrides. Continuing on this path will cost an estimated $200 billion over the next decade, more than offsetting any savings in the reform bill.
A permanent fix needs to be made to the Medicare reimbursement formula, and solutions won’t be politically popular. But putting it off will only make the eventual solution more painful.
Effective health-care reform won’t come in any single bill. It will be an ongoing process, one that has just begun.
