On Wednesday, President Obama spoke to a joint session of Congress on the topic of health care reform. His hope was to bring to an end the bickering and misinformation surrounding the various proposals in Congress while calling on the politicians to pass legislation before the year is out. During the speech, he addressed what he calls him view of what the health care reform bill should contain. Isolating that portion of the text, I am going through the various proposals and provide you my thoughts on their value.
The plan I’m announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health insurance. It will provide insurance to those who don’t. And it will slow the growth of health care costs for our families, our businesses, and our government. It’s a plan that asks everyone to take responsibility for meeting this challenge not just government and insurance companies, but employers and individuals. And its a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans and yes, from some of my opponents in both the primary and general election.
This is a good goal, and probably one most people (from all political spectrums) can support. It would be great if everyone has access to affordable health care insurance if they wish to purchase it. Note the last half of my sentence. It is the personal responsibility of the patient to either seek out insurance coverage or to cover the cost of their medical care out of pocket.
Here are the details that every American needs to know about this plan:
First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.
I have an issue with this line. True, there is nothing in Obama’s plan that would require your employer to change your coverage. However, if we use one of the House bills that offers a public option as an example, if it is cheaper for the company to pay a fee/fine to the government for not providing health care insurance, then it might be in the company’s best interest to drop the benefit. Nothing required them to drop it, but it does save them money in the long run. In turn, the employee would have to seek out the public option as their alternative form of coverage.
What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.
That’s what Americans who have health insurance can expect from this plan more security and stability.
There is a laundry list of items in this paragraph, so let me go down the list:
1. Denying coverage – This is a good proposal. One of the issues many people have with obtaining health insurance in their later years are pre-existing conditions that make them ineligible for coverage. If they are fortunate to find coverage, the cost of the plan is higher than a traditional plan. My concern would be the penalties the government would come up with to punish insurance providers who do deny potential patients.
2. Dropped coverage – This is a vague line and Obama needs to explain this section further. If, for example, you leave your job and your employer allows your insurance coverage to last through the end of the month, unless you pay to extend the plan, the coverage will be dropped. If you get sick the last day of your coverage but don’t seek medical treatment until the next day, it isn’t the fault of the insurance provider for dropping your coverage.
3. Coverage cap – This is a good provision. While it can become costly for an insurance provider if the customer is constantly in and out of the doctor’s office, they can buffer their losses with more customers who are healthy and do not see their doctors that often.
4. Out-of-pocket expenses – As one who was in the hospital last year, you really don’t have a good grasp of how much money you have to pay until you receive the bills. The question here is, do you allow the patients to decide what their co-pay amount will be? Is the co-pay limit applied to the total cost associated with treating the ailment, or is it a per-visit/invoice basis?
5. Preventative care – Costs associated with preventative care and routine check-ups should fall under the out-of-pocket provision discussed above. The President would later go on in his speech to say, “I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.” At what point does the President consider preventative care and Defensive Medicine parting ways? And how does he justify making sure insurance companies don’t charge extra for preventative care while at the same time saying he will save money from the practice? This point needs to be clarified.
Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It’s how everyone in this Congress gets affordable insurance. And its time to give every American the same opportunity that we’ve given ourselves.
This is basically a reframing of the interstate insurance purchasing plan proposed by the Bush Administration a few years ago, and it is a good idea. If you happen to live in a region where you feel your insurance costs are too high for what you are receiving, you should have the option to seek a better package somewhere else. This insurance exchange might run into some road blocks with a few states law that require a certain set of benefits to be provided under the plan, but the insurance companies are sure to devise special packages to meet those requirements.
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who cant get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, its a good idea now, and we should embrace it.
This is where we start to see problems forming. At what level do we determine who is eligible for these tax credits? Is it someone who is above the exempt tax level but live in an area where the cost of living is high? How about the people who are on welfare? This section of the proposal should be isolated and dealt with tax reform legislation. Coupled with either a flat tax or a higher exemption level, this credit could be more accurately applied than under our current tax scale, especially if Obama’s plan need to calculate the size of the credit “based on your need.”
I do agree that there should be a delayed start to this. Much of this legislation has been rushed to this point, and the last thing we need to do is shock the industry with a fast implementation of the reform. The industry needs to have time to digest the proposed changes while economists and social engineers ponder the impact on the consumer.
That’s why under my plan, individuals will be required to carry basic health insurance just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95% of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.
This is where the Constitutional debate will begin. How can the Federal government require individuals to buy a product or service? The example of the automobile insurance is flawed comparison as well. Unlike health insurance, automobile insurance is needed since you are operating a complex piece of machinery that can injure or kill others. This coincides with the state requiring you to prove you are capable of operating this machinery and authorizing you the to use the vehicle on the public roadways.
Going back to the earlier comment made by Obama (“… nothing in this plan will require you or your employer to change the coverage …”), here is where my example comes into play. If the penalty you are going to place on the company were cheaper than what it would cost the company to provide the medical benefit, their bottom line would dictate taking the penalty. Additionally, who would the companies be required to provide medical benefits to: just full-time employees or does that also include part-time employees?
Both of these issues would have to be reviewed by the Courts prior to being implemented. As we’ve seen in the past, some of the grand domestic programs have been deemed unconstitutional, even though they might have vast public and political support.
This is just a quick overview of the President’s proposal (which may or may not match up with the plans being brought forward by the House and Senate). The President did go on to mention:
But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.
I do not think that a public option should be required if the bill already provides a tax credit. This is a duplication of efforts and will cost taxpayers more money. I’m not sure if the President understands this, or if he is intentionally trying to appease the left of his party who are demanding that the reform package contain some sort of public option. The President needs to clarify this point.