The health care debate has dragged on long enough by this point to make even the wonkiest and most passionate among us tire of it. After months of yelling about the public option, benefits for undocumented workers, and the hilarious-cum-terrifying “death panels” fantasia, it seems as though all that can be said has been. The various camps have settled in their ways, and the Senate, as of this writing, has still not produced a deal.
The tragedy is that throughout this debate, we have been having the wrong conversations. Obviously, national time is wasted when government-funded end-of-life care gets demagogued as “death panels,” or when vicious xenophobia leads nativist Congressmen to interrupt presidential speeches. But even the controversy over including a Medicare-style “public option” open to all Americans has distracted from the other, more important, reforms included in almost every health care reform package being discussed. These reforms are just as, if not more, important, and must not be overshadowed by their more controversial counterparts.
Take, for instance, the “guaranteed issue” provision of Senate Finance Committee chairman Max Baucus’s health care reform plan, the stingiest proposal being considered. Currently, health insurers can and do refuse to cover patients with preexisting conditions or those who are deemed too old. Under the Baucus plan, insurance companies would be required to offer an insurance policy to any customer, regardless of their health status, age, or geographic location, to give a few examples.
But insurance companies do not only discriminate against less healthy or older patients by denying them policies. Currently, they are allowed to vary their pricing wildly based on age, whether the patient has a preexisting condition, and so on. Baucus’ plan includes a “modified community rating,” which means that insurers would be required to offer the same policies at the same price to all customers, with adjustments allowed on account on age, tobacco use, and the size of one’s family. The more liberal House and Health, Education, Labor, and Pensions committee proposals do not even allow these adjustments, only allowing a slight change on account of age. Regardless of which bill is passed, all of the current proposals are sure to ban insurers from charging, say, a known diabetic more than a non-diabetic, to give one of many possible examples.
Insurance companies also currently are allowed to cancel coverage by claiming that a patient misled them, most commonly by failing to inform them of a preexisting condition. This practice—known as “rescission”—can leave families without coverage for enormous medical bills that they must then foot single-handedly. Because it tends to occur when a patient becomes seriously ill, the practice hurts those who can bear it least. The Baucus plan, along with every other proposal being considered, will ban rescission.
The existing health care system is perhaps least fair to those who are insured individually. While those who receive coverage through their employer have lower costs due to risk-pooling throughout their workplace, the individually insured often face with catastrophically higher rates. To solve this problem, the Baucus plan establishes state-level exchanges, in which individuals and small groups can come together to buy insurance as one large group, driving down costs dramatically. Indeed, the AARP estimates that an individual could save as much as $4,000 to $6,000 a year through such exchanges. A national, as opposed to state, exchange in which those currently insured through their employer could participate would be even better, as there would be a still greater risk pool. However, any type of exchange is a real improvement that will provide substantial savings to many Americans. Some exchange is in every bill currently being debated.
Even with these reforms, care will probably remain too costly for many Americans. Thankfully, even the Baucus plan provides fairly generous subsidies for the uninsured. Families making up to 300 percent of the poverty line—that is, those making $65,000 a year–would receive tax credits to pay for coverage. Those at the poverty line would never be forced to pay more than three percent of their income in premiums, and those at three times the poverty line would never have to pay more than thirteen percent. For non-premium, out-of-pocket expenses such as copayments, additional government subsidies would set a firm limit on what poor and middle-class families would need to pay per year. In addition, Medicaid would be expanded dramatically to cover those making up to 133 percent of the poverty line–$29,326 a year for a family of four–and encompassing all adults. By contrast, the current Medicaid program is limited to parents and childless disabled persons. These are benefits that help a wide cross-section of America. Note that those making up to $65,000 will benefit, while the average American makes only $50,000 a year. To be sure, these subsidies should be expanded even further, but the fact remains that most Americans would see greatly increased federal assistance in paying for their health care under Baucus’ plan.
This is not to say that liberal activists should stop lobbying for a more aggressive reform package, including a public option. Quite the contrary; having people like Congressman Anthony Weiner and Senator Tom Harkin force the House and Senate leadership to take the views of the left into consideration alongside those of centrists like Ben Nelson is immensely productive, and sets a great precedent. A bill with a public option–and a stronger health exchange, and more generous subsidies, and a stricter ban on insurer price discrimination–would indeed be a better bill, and we applaud Weiner, Harkin, and other liberals for fighting for it.
Where we part ways is with Weiner’s refusal to vote for a bill lacking a public option. To do so would be to deny Americans the right to buy health insurance, to not be charged more for having a chronic disease, to have affordable coverage if individually insured, and to have government assistance if they cannot pay their own way. Simply put, almost any health care bill currently plausible is far better than the status quo. It is the responsibility of the left not just to make the bill as good as possible, but to help pass it as well. The stakes are just too great to fall short.