Slideshow: Governor Shumlin’s Vermont Health Reform Proposal
By Anya Rader Wallack, Ph.D.
Special Assistant to the Governor for Health Care
February 8, 2011
Testimony of Anya Rader Wallack, Ph.D.
Special Assistant to the Governor for Health Care
Joint Meeting of the Senate Health & Welfare and House Health Care Committees on Governor Shumlin’s Health Reform Proposal
February 8, 2011
By DR. RALPH S. BOVARD
Star Tribune, Feb. 7, 2011
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
THE REV. MARTIN LUTHER KING JR.
In a recent commentary (Opinion Exchange, Jan. 23), Dr. Virginia Dale told readers that they must choose between universal health insurance and rationing.
As a physician, I agree that we must get health care costs down if we’re going to achieve universal coverage, but I strongly disagree that the only way to do it is to ration.
There is another viable and proven option: a single-payer or regulated multipayer health care system, such as exists in every nation in the Organization for Economic Co-operation & Development except the United States and Mexico.
The average OECD nation spends 6 percent to 10 percent of GDP on health care; we spend 17 percent. Their per-person spending averages $3,000 to $5,000 a year, compared with $8,000 in the United States.
We could save huge sums — more than enough to insure the uninsured — by cutting the administrative waste and executive profit in our system, and by collective bargaining to lower the price at which drugs, devices and medical services are sold in this country.
The true “elephant in the room,” to use Dale’s metaphor, is the fact that our health care system has been “privatized” by an insurance industry more intent on lining its pockets than on ensuring that the American people get the public service and care that they pay for.
HMOs reap a hugely profitable business by denying and limiting care (a more severe form of rationing than exists in any other OECD nation) and by taking upward of 20 percent from every premium dollar and even tax-funded programs to pay excessive salaries to people who provide no patient care whatsoever.
The 80 percent they are obligated to spend on your health care is called their medical loss ratio. Nice, huh?
In a recent survey, 23 percent of Americans felt they were inappropriately denied care, compared with 4 percent of Canadians.
It was revealing to look at the political cartoons in the same Opinion Exchange section in which Dale’s commentary appeared.
One showed an American with a letter labeled “DENIED” and a caption stating: “50% of all Americans under 65 have preexisting medical conditions that may prevent them from getting insurance … .”
The next image showed a smirking lawmaker in his Washington office with his feet up. The caption: “100% of the 249 congressmen voting to repeal health care have their health care plan paid for by those same Americans … .”
And that is the truth.
The more somber note is that even if the American depicted in that cartoon has health coverage, with the loss of a job or the onset of a major illness that causes the loss of health benefits, he or she may easily join the millions each year who are bankrupted by medical bills.
That doesn’t happen under universal coverage or a single-payer system.
Providing universal health care is not socialistic. It is the pooling of resources by a highly ordered social structure to provide for the common good. Some call it civilization.
Think about it: This is how we fund all of our public services, including fire, police, water, education, libraries, sewage, parks and recreation, and highways. Health care would seem the most essential of public services.
Why do some people call it “socialized” (like it is a dirty word) only when we apply the term to medical care, but not to the other public services that we fund and use daily?
Tommy Douglas, who was voted the “Greatest Canadian” in 2005, nearly 20 years after his death, for bringing a universal health care system to his nation, was a humble clergyman dedicated to the importance of economic democracy and the “social gospel.”
If only our politicians had an ounce of his moral integrity and commitment to serving the nation’s best interests.
It is highly misleading to tell the public that our choice is between continued high numbers of uninsured people or rationing.
Our choice is continued high numbers of the uninsured vs. cutting the enormous administrative waste and corporate profit out of our system with a single-payer system that allows us to lower the prices we pay for medical services, drugs and devices to levels paid in other countries.
As taxpayers and voters, we need to demand accountability, and we are not getting it from our current HMO system. The industry has had more than 20 years to get it right and has failed miserably to do so.
We are getting fleeced. As Paul Wellstone said: “We all do better when we all do better” — not when the CEOs and executives of medical care organizations do obscenely better at the expense of our national health.
Ralph S. Bovard is a steering-committee member of Physicians for a National Health Program-Minnesota Chapter.
http://www.startribune.com/opinion/commentary/115522679.html?elr=KArksc8P:Pc:U0ckkD:aEyKUiD3aPc:_Yyc:aULPQL7PQLanchO7DiUr
By Christopher Snowbeck
TwinCities.com
February 5, 2011
Bloomington-based HealthPartners last year started marketing health plans that feature a network of hospitals and doctors that doesn’t include the Mayo Clinic. In exchange for not having access with low co-payments to the iconic Rochester, Minn., clinic, subscribers pay lower premiums when they select a HealthPartners plan with Mayo as an out-of-network option.
Last year, Eagan-based Blue Cross and Blue Shield of Minnesota also started emphasizing health insurance products for individuals in which Mayo isn’t in the network of providers.
Mayo has been celebrated nationally for providing high-quality and low-cost health care, but health insurance brokers say the local reputation is different as far as cost goes.
“Mayo is cheap only compared to other national care centers, but in general is a higher-cost center when compared to its Minnesota peers,” said Christopher Schneeman, a health insurance broker with SevenHills Benefit Partners in St. Paul.
“The Mayo Clinic is world-class,” said Greg Sailer of Sailer Benefit Services in Lake Elmo. “But it’s expensive, and you’re going to pay for it.”
Mayo Clinic officials argue that the Rochester center offers greater value by providing comprehensive care that steers patients to the most-effective treatments. That ultimately adds up to lower overall cost, the clinic says.
“When we looked at Mayo’s total cost of care — the combination of price and utilization — they, on average, have a higher total cost of care than other health systems that are seeing comparable groups of patients,” said (Andrea Walsh, chief marketing officer of HealthPartners).
http://www.twincities.com/ci_17298533
By Don McCanne, MD
For many years, the most common example given of the variations in the costs of health care demonstrated by the Dartmouth Atlas was the high costs of health care in Boca Raton, Florida when compared to Rochester, Minnesota, home of the Mayo clinic. These observed variations throughout the nation have led to the recommendation – now enacted in the Affordable Care Act (ACA) – to establish accountable care organizations (ACOs).
Although the precise details of what constitutes an ACO have not yet been released by HHS, the law states that the ACO will be “accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it.” Payment will be based on a “Medicare Shared Savings Program,” in which the ACO shares with the government the savings for which it is accountable. It is a program designed to reduce health care spending.
Since Mayo Clinic certainly has the capability of providing overall care of the patient, it would seem to be an ideal institution to serve as an ACO. In fact, the authors of the legislation had in mind institutions such as Mayo as important models that could provide high quality care at a lower cost.
But will Mayo deliver at a lower cost? Not according to the current experience in Minnesota. Mayo argues that they provide greater value because they provide “comprehensive care that steers patients to the most-effective treatments,” even if that care is more expensive than elsewhere in Minnesota. (Time for a little soft shoe?)
The point is that the cost savings in ACA, such as the ACOs, are not much more than a fantasy at this point. And for this we gave up universal coverage and have established under-insurance as the new standard. We can still reach our goals of comprehensive, affordable care for everyone by replacing ACA’s financing system with an improved Medicare for all.
Some insurance companies pushing plans with Mayo Clinic out of network
By Christopher Snowbeck
TwinCities.com
February 5, 2011Bloomington-based HealthPartners last year started marketing health plans that feature a network of hospitals and doctors that doesn’t include the Mayo Clinic. In exchange for not having access with low co-payments to the iconic Rochester, Minn., clinic, subscribers pay lower premiums when they select a HealthPartners plan with Mayo as an out-of-network option.
Last year, Eagan-based Blue Cross and Blue Shield of Minnesota also started emphasizing health insurance products for individuals in which Mayo isn’t in the network of providers.
Mayo has been celebrated nationally for providing high-quality and low-cost health care, but health insurance brokers say the local reputation is different as far as cost goes.
“Mayo is cheap only compared to other national care centers, but in general is a higher-cost center when compared to its Minnesota peers,” said Christopher Schneeman, a health insurance broker with SevenHills Benefit Partners in St. Paul.
“The Mayo Clinic is world-class,” said Greg Sailer of Sailer Benefit Services in Lake Elmo. “But it’s expensive, and you’re going to pay for it.”
Mayo Clinic officials argue that the Rochester center offers greater value by providing comprehensive care that steers patients to the most-effective treatments. That ultimately adds up to lower overall cost, the clinic says.
“When we looked at Mayo’s total cost of care — the combination of price and utilization — they, on average, have a higher total cost of care than other health systems that are seeing comparable groups of patients,” said (Andrea Walsh, chief marketing officer of HealthPartners).
For many years, the most common example given of the variations in the costs of health care demonstrated by the Dartmouth Atlas was the high costs of health care in Boca Raton, Florida when compared to Rochester, Minnesota, home of the Mayo clinic. These observed variations throughout the nation have led to the recommendation – now enacted in the Affordable Care Act (ACA) – to establish accountable care organizations (ACOs).
Although the precise details of what constitutes an ACO have not yet been released by HHS, the law states that the ACO will be “accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it.” Payment will be based on a “Medicare Shared Savings Program,” in which the ACO shares with the government the savings for which it is accountable. It is a program designed to reduce health care spending.
Since Mayo Clinic certainly has the capability of providing overall care of the patient, it would seem to be an ideal institution to serve as an ACO. In fact, the authors of the legislation had in mind institutions such as Mayo as important models that could provide high quality care at a lower cost.
But will Mayo deliver at a lower cost? Not according to the current experience in Minnesota. Mayo argues that they provide greater value because they provide “comprehensive care that steers patients to the most-effective treatments,” even if that care is more expensive than elsewhere in Minnesota. (Time for a little soft shoe?)
The point is that the cost savings in ACA, such as the ACOs, are not much more than a fantasy at this point. And for this we gave up universal coverage and have established under-insurance as the new standard. We can still reach our goals of comprehensive, affordable care for everyone by replacing ACA’s financing system with an improved Medicare for all.
Letter, The New York Times
Published: February 5, 2011
To the Editor:
Re “For Governors of Both Parties, Medicaid Looks Ripe to Slash” (front page, Jan. 29):
It is hard for me to understand why the governors, along with corporate chief executives, aren’t lobbying Congress and President Obama for single-payer health insurance.
It would take the burden of providing health insurance off state and corporate budgets and provide the broadest and least expensive health care solution.
Charles Pack
Red Bank, N.J., Jan. 29, 2011
By PHILIP CAPER, JOE LENDVAI and JULIE PEASE
The Portland (Maine) Press Herald
February 6, 2011
There has been a great deal of discussion recently about health care reform in America and in Maine. Many Republicans want to repeal last year’s federal health care reform law, and most Democrats want to implement and improve it.
In the meantime, pending full implementation of the law in 2014, health care costs for individuals, employers and the government continue to soar, and the number of uninsured Americans (including Mainers) continues to grow.
Many Americans believe that the forces of the marketplace can solve our health care problems. They won’t, and they can’t. We have been trying marketplace solutions for more than 30 years.
These “solutions” have led to out-of-control costs, rising numbers of uninsured and under-insured patients, the disappearance of primary care providers, fragmented and duplicative care, and a brutal system dominated by for-profit health insurance companies.
In this system, denial of care is the means to increasing profitability. Marketplace solutions have failed.
America spends about twice as much per-person on health care as the average of all other developed countries, even though those countries are able to provide health care to all of their residents.
Furthermore, by almost every measurement, other developed countries have better health care outcomes than we do, and their health care systems are almost universally popular with their people (including their politicians).
How do they do it?
First, only in America is health care considered a business. The mission of a business is to create wealth for its shareholders.
The mission of a health care system is to prevent disease where that is possible, and to diagnose, treat, cure, heal and comfort patients when they are ill.
Only in America has the business mission been permitted to trump the health care mission.
In all other developed countries, health care is financed by the government or nonprofit funds that are tightly regulated by government and run as public utilities. The for-profit financing of health care is not permitted for basic health care services.
Second, only in America is there such fragmentation of health care systems, with multiple tiers of care provided by Medicare, Medicaid, the VA, Tricare and private insurance.
In most other developed countries, everybody is in the same system. With everybody in the same system, everybody has an interest in seeing that the system is adequately funded and run effectively and efficiently.
Third, all other countries have some way of budgeting for health care for all of their citizens.
In America, the system for the civilian population is totally open-ended. Neither the federal government nor the states has yet shown the political will to control costs.
Some states are beginning to apply the brakes, but only if cost restraint is applied selectively to their most vulnerable and politically disenfranchised populations.
It is time for Mainers to replace our fragmented, expensive and fundamentally unfair health insurance system with a single statewide program of health care financing — everybody in, nobody out.
In recent testimony before the Maine Legislature, professor William Hsiao of Harvard University, one of the world’s leading authorities on the financing of health care, estimated that Mainers could save $1 billion in the first year of such a system, and permanently reduce the rate of health care cost increases by 2 percent per year thereafter.
Some of the savings would come from eliminating excessive insurance company profits and executive compensation.
More would come from standardizing benefits and coverage, eliminating the huge administrative costs that doctors, hospitals and other providers of health care incur in dealing with hundreds of plans.
Still more would come from eliminating the fights about money that are a byproduct of so many different insurance programs — who pays, what for, how much — that now consume so much time and effort, and impede the delivery of quality health care.
Replacing our profit-driven system of financing health care with a mission-driven nonprofit system is the necessary first step in reinventing health care in Maine.
Only then will we be able to address the need to effectively reform the way we pay hospitals and other health care providers to reward efficiency and outcomes, rather than profit and volume.
Maine AllCare proposes nothing less than reforming the culture of health care throughout Maine.
Maine AllCare’s vision is for a system for Maine in which:
• All Mainers have access to affordable and appropriate health care and its supporting social and community services.
• No Mainer is in danger of financial ruin because of health care costs or is locked into a job solely because it provides health insurance.
• No Maine employer is faced with health care costs spiraling out of control.
• No Maine worker is faced with stagnant or declining wages or the inability to bargain for better working conditions because of the rising cost of health care.
• Maine patients will no longer have to wonder whether their doctor’s treatment decisions are driven by their health needs or their insurance coverage.
• Maine doctors will no longer have their clinical judgment second-guessed by insurance companies. Medical practice will be decided by health care providers and patients, and will return to being driven by mission, not money.
• Maine hospital executives will be free to offer services determined by the needs of their community, not their need or desire to generate revenue.
• The Legislature will not have to stand by and watch rising MaineCare and state and local government employee costs steadily erode its ability to address other critical priorities.
Can it be done? Absolutely. There are plenty of examples from around the world. All other industrialized countries, many less wealthy than ours, are already doing it.
Can we do it? That depends upon the people of Maine.
The authors serve on the board of directors of Maine AllCare, a nonpartisan, nonprofit group committed to educating the public and policymakers about how to improve on the Patient Protection and Affordable Care Act to make health care in Maine universal, accessible and affordable for all.
By Cheryl R. Clark, Jane Soukup, Usha Govindarajulu, Heather E. Riden, Dora A. Tovar and Paula A. Johnson
Health Affairs
February 2011
Did the Massachusetts health reforms, which provided near-universal insurance coverage, also address problems of unmet need resulting from the cost of care and of inadequate preventive care for diverse patient groups? We found that nearly a quarter of adults who were in fair or poor health reported being unable to see a doctor because of cost during the implementation of the reforms. We also found that state residents earning less than $25,000 per year were much less likely than higher earners to receive screening for cardiovascular disease and cancer.
http://content.healthaffairs.org/content/30/2/247#aff-6
And…
By Kay Lazar
The Boston Globe
February 7, 2011
Massachusetts regulators granted more exemptions last year to residents who said they could not afford the health insurance required by the state, waiving the tax penalty for more than half of those who appealed, according to state data.
That is prompting regulators to take a fresh look at how Massachusetts defines affordable when it comes to mandatory health insurance.
Massachusetts residents with the lowest family incomes, less than $33,075 for a family of four, make up the largest share — 43 percent — of the uninsured, according to state data.
“We may want to let them in [to government subsidized health insurance], but it would cost money, and we would have to decide if the state wants to spend money that way,” said committee member Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology.
By Don McCanne, MD
Does an individual mandate to purchase private insurance with cost-sharing requirements ensure that citizens will have health care access and be able to afford it? It hasn’t in Massachusetts, and it will not throughout the United States because it is an irreparably flawed mechanism of financing health care.
The literature is replete with policies that would nudge us a little bit closer to the goals of affordability and expanded coverage, but, as Jonathan Gruber, an advocate of the private insurance mandate model, says, “we would have to decide if the state wants to spend money that way.”
But it’s the model, stupid! Dump it and replace it with an improved Medicare for all and then health care will be affordable for everyone. Why does Gruber and the others insist on separating state money from personal money, as if state money is sacred and personal money isn’t? It all belongs to us anyway.
Lack Of Access Due To Costs Remains A Problem For Some In Massachusetts Despite The State’s Health Reforms
By Cheryl R. Clark, Jane Soukup, Usha Govindarajulu, Heather E. Riden, Dora A. Tovar and Paula A. Johnson
Health Affairs
February 2011Did the Massachusetts health reforms, which provided near-universal insurance coverage, also address problems of unmet need resulting from the cost of care and of inadequate preventive care for diverse patient groups? We found that nearly a quarter of adults who were in fair or poor health reported being unable to see a doctor because of cost during the implementation of the reforms. We also found that state residents earning less than $25,000 per year were much less likely than higher earners to receive screening for cardiovascular disease and cancer.
And…
More get waivers of health insurance
By Kay Lazar
The Boston Globe
February 7, 2011Massachusetts regulators granted more exemptions last year to residents who said they could not afford the health insurance required by the state, waiving the tax penalty for more than half of those who appealed, according to state data.
That is prompting regulators to take a fresh look at how Massachusetts defines affordable when it comes to mandatory health insurance.
Massachusetts residents with the lowest family incomes, less than $33,075 for a family of four, make up the largest share — 43 percent — of the uninsured, according to state data.
“We may want to let them in [to government subsidized health insurance], but it would cost money, and we would have to decide if the state wants to spend money that way,” said committee member Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology.
Does an individual mandate to purchase private insurance with cost-sharing requirements ensure that citizens will have health care access and be able to afford it? It hasn’t in Massachusetts, and it will not throughout the United States because it is an irreparably flawed mechanism of financing health care.
The literature is replete with policies that would nudge us a little bit closer to the goals of affordability and expanded coverage, but, as Jonathan Gruber, an advocate of the private insurance mandate model, says, “we would have to decide if the state wants to spend money that way.”
But it’s the model, stupid! Dump it and replace it with an improved Medicare for all and then health care will be affordable for everyone. Why does Gruber and the others insist on separating state money from personal money, as if state money is sacred and personal money isn’t? It all belongs to us anyway.
By Robert Reich
The Business Insider, Feb. 4, 2011
The Republican-led house vote to repeal the new health care law is purely symbolic. But there’s one provision of the law that Republicans are likely to try to defund, and they may have the public with them on this. It’s the so-called “individual mandate” – the requirement that everyone purchase health insurance, or pay a fine. According to a recent poll, 60 percent of the public opposes it. They just don’t like the idea of government telling them they have to buy something.
The mandate is also particularly vulnerable to legal challenge. So far, two federal judges, one in Virginia and another in Florida, have struck it down. They say the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy and consume broccoli, or asparagus. The Florida judge referred to broccoli; the Virginia judge to asparagus.
Yet the new system can’t work without the individual mandate. Only if everyone buys insurance can insurers afford to cover people with preexisting conditions, or pay the costs of catastrophic diseases.
The curious thing is Americans don’t mind individual mandates when they come in the form of payroll taxes to buy mandatory public insurance. In fact, that’s the system we call Social Security and Medicare, and both are so popular politicians dare not touch them.
And no federal judge has struck down Social Security or Medicare as being unconstitutional requirements that Americans buy something.
Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.
So if the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.
By Deborah Richter
Burlington Free Press, Feb. 1, 2011
Praise has been heaped on the 120-some page report issued by the Harvard health economist, William Hsiao, and his working group. Words like historic, ground-breaking, and masterful are used, and since I entirely agree I will put them to use as well.
The report is called “Act 128 Health System Reform Design: Achieving Affordable Universal Health Care in Vermont” but will forever be known as the Hsiao Report.
It does exactly what is was asked by the Legislature. It outlines the designs for three health care systems and offers the rationale behind the thinking for each, including facts, figures and the probable economic consequences. For Vermont, this is ground breaking.
Two of the three look good. One of them (the second, which is called the public option) is hardly in the running because effectively it will not achieve universal coverage.
The favored system designs have numbers. Option No. 1 is a single-payer system. Option No. 3 is a single-payer system. What is the difference? Not a lot. Operationally there are differences. But at this stage, far more important is what they share. It is something of overriding importance that we overlook at our peril, and in fact have overlooked at our peril for years. That peril can be described as unsustainable rises in costs.
Here is the Hsiao Report: “Vermont will need to reorganize existing systems and develop new administrative capacities to manage an integrated, single-payer health system. In addition, the state will need to institute a regulatory apparatus to oversee the functioning of the system.”
This admonition appears about nine-tenths of the way through the report, but it is the key to everything.
Our Legislature and new administration are called on to create an integrated health care system. System is not an idle idea. Without a system the costs of health care in our state cannot be managed, contained, controlled, budgeted and will in fact remain unmanaged, uncontained, uncontrolled, unbudgeted.
The Hsiao Report is a masterful piece of work. It is specific to Vermont, to our health care, to our economy, to our political landscape and to Vermont’s intersection with federal laws, regulations and, by implication, politics. It is not a template for other states. It is not a one-size fits all. It is particular to our state.
Vermont has never before had anything close to this to work with. It maps out routes to a goal that can be abbreviated as “high-quality health care for all Vermonters,” and by affordable is meant affordable to Vermont as a whole as well as to individuals.
Comments after its release Jan. 19 no doubt are pouring in. Because they are by post or e-mail we can’t know what they are. But the usual pattern is reservations, objections, gloomy prognostications, alternative theories, quarrels over details, complaints from idealists, self-interested criticisms from the what-about-me crowd, some valuable, some a deplorable waste of time, but all more or less beside the main point.
As the Hsiao Report implies in its gentle way, if we don’t move to an integrated health care system that is uniform and regulated we are done. The costs are going to bury us. That is the essential point.
A system oversees and coordinates. It integrates. At some basic level it abolishes the what-about-me chorus in favor of what-about-all-of-us. A system takes the fundamentally necessary step of grounding health care, and all of its elements, solidly in the realm of the public interest.
The Hsiao Report is a report, not a bill. It hands the Legislature and the new administration an historic opportunity.
The draft, or redraft, will be subject to the usual practice in committees and hearings — the standard back and forth of legislation — of picking away at the details (“the devil is in the details”). Not this time. This time the devil will be found in our failure to create and implement a system.
Dr. Deborah Richter of Montpelier is president of Vermont Health Care for All, which is campaigning for a single-payer health care system for Vermont.
By Matt Miller
The Washington Post, Thursday, February 3, 2011
“Good afternoon, I’m Brian Williams reporting from Washington, where it looks like October 26, 2017, will be a day that truly goes down in history. In a few moments, at a table not far from where I now stand, President Hillary Clinton will sign into law the universal health-care legislation – “Medicare for All,” as she calls it – that completes a journey Mrs. Clinton began nearly 25 years ago. Back then, as first lady, her attempt to reform the health-care system proved a fiasco that cost Democrats their hold on power. Who would have thought then – or later, when President Barack Obama’s big health reform was overturned by the Supreme Court in a controversial 5 to 4 ruling in 2012 – that today’s bipartisan bill would be the result? For some perspective on the twists and turns of history, we’re joined by NBC’s David Gregory. David, health reform seemed dead in the water in 2012. How did we get from that Supreme Court ruling to today?”
“Brian, when historians look back on this period, they’ll see it as a classic case of shortsighted politics – of Republicans winning the battle but losing the war. It really dates to the fight to overturn Barack Obama’s health reform. There’s no question the GOP got a boost from that ‘victory’ – it galvanized their base, and, combined with high unemployment and the dollar crisis right before the 2012 election, denied President Obama a second term.
“But some Republicans now say the trouble was that their party never acknowledged that health care wasn’t just about politics – it was a major policy problem that needed real solutions. President Mitch Daniels, of course, had to spend virtually all of his term in office getting America’s fiscal house in order, what with the International Monetary Fund and the rating agencies telling Washington the jig was up. The new carbon and value-added taxes he enacted, and the spending cuts he muscled through, left Daniels respected but hardly popular.
“Meanwhile, as you know, Brian, health costs kept soaring, employers kept dropping coverage they could no longer afford, and by the 2016 campaign, with 70 million Americans uninsured, something had to give. It was Hillary Clinton’s moment, Brian.”
“David, it seems hard to recall now, but back in the fight over Obamacare, Republicans only offered plans to insure 3 million of the 50 million who were uninsured back then. Today, most Republicans have signed on to Mrs. Clinton’s plan to have government provide every American with basic coverage, with a much more modest role for private insurance as a supplement. What accounts for the change?”
“Well, Brian, a cynic might say that when you get to 70 million uninsured, some of them are actually Republican voters! But the key difference was the way business and labor came together behind Mrs. Clinton’s approach. Top chief executives agreed companies shouldn’t be expected to bear these costs anymore and backed the modest taxes needed to move health costs from private payrolls to public budgets, as happens in every other wealthy nation. The unions finally took a larger view, too. Instead of moaning about the ‘loss’ of a benefit they’d bargained for, labor leaders accepted that most workers had gone years without real wage increases, because health costs were devouring every penny available for compensation. Having government fund health care was the only way to give Americans a raise.”
“What seems so ironic, David, is that Republicans now endorse a much more ‘liberal’ solution than they would have had if they’d supported Barack Obama’s approach years ago.”
“That’s right, Brian. Obama modeled his reform on Mitt Romney’s in Massachusetts. It had an individual mandate because of something Republicans privately understood: The only way to reach universal coverage through private health plans that cover folks regardless of health status is to require everyone to be in the insurance pool. If people are free to wait until they’re sick to buy in, premiums soar and coverage erodes. Republicans who knew better assailed the mandate not because they really cared about some constitutional defect – after all, that could have been fixed easily by structuring incentives to buy coverage as opposed to a mandate. They did it because it was a way to take a bite out of Obama. In the near term, it worked. In the long term, they lost the chance to preserve the private-sector role they claimed to cherish in health care.”
“Ironic indeed. We’re getting word that President Clinton is about to speak. We join her now in the Rose Garden.”
“Thank you all for being here. It’s hard to imagine a better 70th birthday present for a president than the law I am about to sign. . . .”
Matt Miller, a senior fellow at the Center for American Progress and co-host of public radio’s “Left, Right & Center,” writes a weekly column for The Post. He can be reached at mattino2@gmail.com. Follow him on Twitter at @mattmillernow.
http://www.washingtonpost.com/wp-dyn/content/article/2011/02/02/AR2011020203149.html