INSURANCE

It's hardly surprising that some Democrats want to run away from health reform. The Republican victory in Massachusetts' special Senate election last month made the issue even more radioactive than it was last summer, when members of Congress were shouted down at town hall meetings.

But none of the problems that made an overhaul of the health care system necessary has gone away. People still can't get medical coverage because they have pre-existing conditions; people who have insurance go bankrupt because insurers cap their coverage for serious illnesses; and people lose their insurance when they lose their jobs. To support this dysfunctional system, the USA spends more of its wealth than any industrialized nation and covers a lower percentage of its citizens. Meanwhile, premiums are doubling every decade, assuring the system's eventual collapse.

The only reasons for delay are short-term and political. It's expedient to punt. But Democrats are delusional if they think they'll inoculate themselves against attacks this fall by backtracking. No one wins by trying and failing. Nor, in the long run, does anyone win by simply stonewalling in the midst of crisis, as the Republicans have done. The problem still has to be solved.

But how?

A Kaiser Family Foundation poll last month shows the individual pieces of reform are more popular than the legislation as a whole. That suggests supporters could make headway if they were as clever at explaining the virtues of the bill as critics are at mischaracterizing it as a "government takeover."

So here are five suggestions for getting the job done:

1. Get rid of the sweetheart deals. Desperate to get the bill through the Senate, negotiators gave hundreds of millions of dollars to Nebraska and Louisiana to help pay those states' share of expanding Medicaid costs. Later, House-Senate negotiators agreed to suspend the tax on expensive insurance plans enjoyed by some unionized workers and executives until 2018. Not surprisingly, these and other blatantly unfair giveaways infuriated the public and hurt support for the bill. They should go.
2. Beef up the cost controls. Nothing is more important, and nothing is more politically distasteful. But there are at least a few options for getting started. The Senate-passed bill is much tougher than the House version in controlling costs, so it's imperative to at least hold the line on provisions such as the tax on premium plans and creating a commission that can recommend cost-saving measures for Medicare. That commission could be given more teeth by removing exemptions that shield hospitals and hospices until 2020 and letting the panel look at the whole range of ways to fix Medicare, including raising taxes and changing coverage. It also should be bipartisan, but Republicans refuse to support the idea unless the commission is barred from considering tax hikes. Better to weigh its recommendations after the fact.
3. Rethink the individual mandate. Many critics question the constitutionality of requiring people to buy private insurance and bridle at fining those who don't. Although the mandate would probably survive constitutional muster, some other options are worth considering. If someone refused to sign up but later got sick and sought coverage (which insurers would have to provide), that person might have to pay a year's worth of premiums to get covered. Or, as some conservatives have suggested, every American could be automatically enrolled in a health plan with the right to opt out. If someone opted out but later demanded coverage, they could face a significant penalty.

   Some such requirement is the trade-off for ending egregious insurance practices such as raising people's premiums when they get sick or refusing to insure them at all. If instead, insurance companies are simply forced to take on sicker, riskier people, they will inevitably raise premiums for existing customers.

4. Add malpractice reform. Democrats resisted any true malpractice reform provision, painting themselves as captives of the trial lawyers' lobby. The Congressional Budget Office says efforts to restrain malpractice awards and cut down on "defensive medicine" could save $54 billion over 10 years. That's enough to make this worth including.
5. Make lawmakers experience the insecurity. Our final proposal has nothing to do with political reality, but everything to do with accountability and fairness. Members of Congress enjoy some of the best health insurance in the nation. It's a job perk, heavily subsidized by taxpayers. In some cases, members with as little as five years in Congress can keep the medical coverage even if they're voted out of office.

So while millions of Americans have no insurance or risk losing it if they're laid off, senators and representatives feel none of that fear themselves. We suggest they agree to forgo using taxpayer money to pay for their insurance until they make sure every taxpayer can get covered. That might increase their sense of urgency a bit, and it strikes us as eminently fair.

Source: USATODAY.com   February 2010