Question: I’m confused about health care reform. Now that both houses of Congress have passed a bill, what will happen next?
Originally published as “There is a huge cost in doing nothing,” an Opinion piece by Leo P. Brideau, President/CEO of Columbia St. Mary’s Health System, in the October 17, 2009, issue of the Milwaukee Journal Sentinel. Updated December 28, 2009, by Leo P. Brideau.
Answer: Maybe the only people not confused by the debate on health care reform are those who've completely ignored the subject. Americans seems to be equally divided between those who believe health care reform is essential and those who believe it poses a serious threat. And now that both houses of Congress have passed a health care bill and Congress appears ready to try to produce a single piece of legislation, we can expect that interest groups on both sides will continue to oppose its ultimate passage.
So, what are we to believe about this health reform legislation? The picture might clear up if we try to answer two simple questions: What is likely to happen if Congress passes health care reform? And what is likely to happen if it doesn't?
Opponents of health care reform predict that it will lead to a government takeover of health care, rationing of needed care, a budget-breaking increase in government spending, erosion of the Medicare program and disruption of the doctor-patient relationship. What's the truth? Let's examine the key aspects of the House and Senate bills.
The nonpartisan Congressional Budget Office (CBO) estimates that the Senate proposal would result in securing insurance coverage for 31 million more Americans at a total cost of $871 billion over ten years. The CBO estimates the bill will pay for itself and actually will reduce the federal budget deficit by $132 billion over that same period. The House version covers an additional 36 million Americans at a cost of $1,052 billion and reduces the federal deficit by $139 billion.
The House and Senate versions disagree on whether there will be a government-sponsored health plan offered through the insurance exchanges. The House bill includes a “public option” and the Senate does not. Because the vote is so close in the Senate it is likely that its language will prevail and the final bill will not contain a public option.
Both bills include over $400 billion in cuts to Medicare providers, reductions that are significant but not serious enough to cause hospitals or doctors to turn away Medicare patients. In fact, doctors would get a slight increase in payments. The bills also provide for very important insurance market reforms for individuals and small employers.
Either proposal is far from perfect. Premium subsidies for low- and middle-income people are too small and mandates that require individuals to get insurance are too weak. Nonetheless, it's a substantial down payment on reform that will accomplish a lot, including:
A major reduction in the number of Americans without health insurance.
Insurance reforms like the elimination of pre-existing condition exclusions, guaranteed issue of insurance policies and community rating to make premiums more affordable.
Slowing the rate of growth of health care costs.
Helping to balance the federal budget.
Phasing in payment reform that will begin to pay doctors and hospitals for value, not just for volume.
What happens if Congress fails to act? We don't need to look very far for the answer.
The last opportunity Congress had to deal with health care reform was in 1994 when it soundly defeated the Clinton health care reform plan. I'm not arguing in favor of the Clinton plan; it was badly flawed. But Congress offered no alternative, and we have stood still for 15 years. What has happened in that time?
Seven million more Americans lost their health insurance.
Those who still have insurance pay much higher premiums for less and less coverage.
Medical bills have become the leading cause of personal bankruptcy in America, accounting for more than 60% of the 1.4 million personal bankruptcies projected for 2009.
Workers' pay increases have been eaten up by higher health insurance premiums.
High insurance premiums have seriously damaged the competitiveness of American businesses and cost jobs. The only significant job growth has been in health care.
The costs of Medicare and Medicaid are the largest single source of federal and state budget deficits. State and federal budget crises will not be solved without health care reform.
The plain fact is that health care is eating our economy.
Those who argue in favor of keeping things the way they are fail to understand that the status quo is no longer an option. It is completely unsustainable. Those whose view is "I've got mine, and I don't want to lose it" don't understand that without fundamental health care reform they will lose their coverage. Reform is our only option for keeping something resembling what we have.
If we do nothing, what do the next 10 years have in store?
Americans are losing insurance coverage at the rate of 1 million people per year. At that rate, at least 10 million more Americans will lose their insurance coverage. And the Urban Institute, using the methodology of the prestigious Institute of Medicine, estimates that lack of insurance results in the death of more than 20,000 Americans per year.
Eight years from now, the Trust Fund that pays hospitals to care for Medicare patients will be completely broke.
Seven years from now, it is estimated that the cost of a family medical policy will consume between 33% and 45% of the median family income. Health insurance will cost more than housing.
Health care costs will produce even greater federal and state budget deficits, which ultimately will cripple our economy.
Doing nothing is irresponsible. We can't afford to wait for the perfect health care reform bill. This debate is at least as much about the viability of the American economy as it is about health care. The time for courageous leadership from our elected officials is now.
Democrats who threaten to not vote for a bill if it has no public option are as wrong as some Republicans who see the defeat of health care reform as an opportunity to hand President Barack Obama an embarrassing defeat. Our country cannot afford to have destructive politics or rigid ideology get in the way of doing what is right.
In his memoir published shortly after his death, Massachusetts Sen. Ted Kennedy recounts a conversation he had with Louisiana Sen. Russell Long at the time of Long's retirement from the Senate. Long said to Kennedy, "Once in a while around here you do something that you believe in - that's right."
It's time today for our elected leaders to do something that's right for the American people. There's no tomorrow for reforming our broken system of health care.
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