Tuesday, March 23, 2010

The New Health Care Bill

Every now and again there's one of those situations where I hope that events prove me completely wrong. The health care bill is one of those times, since it looks like the monstrosity that they are considering is going to become law very soon.

I don't agree with the more "excitable" critics who argue that the new legislation would "socialize" a big chunk of the American economy or result in the sort of rationing that would create "death panels" or even that the law would take away anyone's Medicare. Instead, my objection is that this has the combination of paying out massive amounts of federal dollars (as well as dollars coming from individuals and companies) to the insurance companies without demonstrating in any convincing way where this money would come from. The excise taxes and Medicare cuts would come far enough down the road that I have no confidence that a future Congress wouldn't do the politically expedient thing and delay these fixes further. After all, today's Congress had a hard enough time just passing the goodies without the pain. What makes anyone think that a future Congress will be less cowardly? On top of this, I haven't seen a convincing reason why this would bring down health care costs. Or am I missing something key here? Even simple fixes that were proposed by the Republicans were left out of the bill, such as tort reform (admittedly not a panacea for the whole problem but to me an obviously needed fix anyway) or having health insurance companies regulated on a national level so they can compete across state lines. (Granted, the Republicans are largely responsible for this mess since they refused to participate from the beginning, ensuring that they would have no influence on the final bill.) Introducing transparency and accountability to the health care industry could have gone a long way to bringing costs down, making it much easier to expand coverage in a way that our budget could withstand.

Another fix I'd have liked to see would be separating the connection between health coverage and employment, so that individuals would be able to hold the insurers more directly accountable, and could be more directly subsidized. It'd also make employees more willing to switch jobs or start their own businesses, without worrying about losing their coverage. And a public option might have had the benefit of controlling costs, as a government "last resort" program could have had the bargaining power to get best rates on procedures and medicines.

I'm all in favor of reforming our current health care system--and expanding coverage to more people. But it always seemed to me that the first goal of any new entitlement program is to find a convincing way to pay for it. The problems with Social Security and Medicare today are that the projected spending is far outstripping projected income. If Congress can't even address those very real threats to our long term fiscal health, it gives me no confidence that this new thing won't be a disaster. I hope I turn out to be wrong here.

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