The U.S. lawmakers continue to debate the details of what may bring a transformation of the nation’s health-care system. The cost of the incomplete plan drafted by the Senate Health, Education, Labor and Pensions Committee was recently reduced to about $1 trillion over 10 years.
What, exactly, is that $1 trillion supposed to buy America? The plan seems to consist of three major components: providing health insurance coverage to all Americans; changing medical care so it’s less expensive and of better quality; and investing in public health prevention. Although, no fully formed proposals have emerged so far, here are some key elements and why or why not our government should do it:
1. Create a government-sponsored health insurance plan
Do it: About 47 million Americans don’t have insurance, mostly because it’s unaffordable or unavailable. A “public plan” would compete with private insurance plans, and President Obama contends it would help reduce costs. It could be offered more cheaply because of the government’s buying power and the fact that it wouldn’t need to turn a profit or spend millions on advertising. Consumer groups and many Democratic lawmakers are its biggest supporters.
Don’t do it: A government plan with those advantages might draw so many customers away from private insurance that those companies fail. And if a public plan underpaid doctors—as health care providers claim Medicare and Medicaid do—health care providers might drop out of the program and then patients would have fewer physicians and fewer choices. Many Republican lawmakers, private insurance companies and The Pharmaceutical Research and Manufacturers of America (PhRMA) are against it.
2. Require individuals to have health insurance and employers to provide help getting it
Do it: Many uninsured people end up in the emergency room with expensive medical problems because they didn’t get treated earlier. This causes unnecessary costs and health problems. Most parties agree that a major overhaul of health care won’t work until everyone has insurance coverage. Moreover, expanding the pool of people buying health insurance adds younger people who do not need expensive care and will help keep insurance prices lower. An employer mandate with a “pay or play” option would force businesses to provide insurance for workers or pay into a system that would cover the uninsured.
Don’t do it: Healthy younger workers without a lot of income, who often choose not to be covered, might not want to bear the cost. And businesses complain that their health care costs are already so high they can’t compete globally. Some states have considered an individual mandate, though most have pulled away considering the expense of subsidizing those whom it requires to have coverage, but who can’t afford it. Labor unions, consumer groups and small businesses are likely to oppose this mandate.
3. Help workers ages 50 to 64 get health insurance
Do it: Insurance premiums are expensive and often unavailable for this age group because they tend to have more medical problems. But the faltering economy has triggered widespread layoffs, forcing many Americans ages 50 to 64 to lose their jobs and thus their employee health insurance. In the most recent figures, 7.1 million adults in this age group had no coverage.
Don’t do it: It’s expensive. Allowing those 50 to 64 years old to buy into the Medicare system could bankrupt that program if they were allowed the same subsidies as Medicare beneficiaries. Without any subsidies, most in this age group could not afford to buy into the program. And asking insurance companies not to charge them so much more, based on their age, could mean that younger workers have to pay more.
4. Spending more than $1 trillion for a major overhaul of health care that improves access to coverage and quality of care.
Do it: Health care costs are climbing so fast they are consuming more than 17 percent of the total economy. These costs are hurting businesses that offer coverage to their employees. And more and more Americans are without basic medical treatment because they don’t have access to affordable health care. In order to come up with $634 billion of the $1 trillion-plus needed for this major reform, President Obama proposed cutting Medicare payment rates to medical providers and raising taxes on the wealthy.
Don’t do it: Almost everyone involved agrees that health care reform is important—and expensive. Where will the money to fund it come from? Taxpayers, of course!
5. More government regulation of health care
Do it: If the government requires everyone to have some minimum health care coverage, it likely will have to define and regulate what that coverage must include and how people can get it. Consumer advocates and small businesses say the current system doesn’t work because individuals and small companies can’t find affordable coverage.
Don’t do it: Many people fear a centralized government program that has too much control over medical care. Conservative groups mostly against it because they fear more government involvement in insurance could lead to more red tape and inefficiencies.
6. Reducing health care costs
Do it: Health care costs are rising so fast they are gobbling up ever larger portions of the federal budget, family incomes and business spending. Those costs tripled between 1990 and 2007, and if no changes are made, health care costs will account for 25 percent of the nation’s economy by the year 2025.
Don’t do it: While most people say it’s necessary to cut costs, they don’t agree on how it should be done. Some ideas win wide support, while others have both supporters and detractors. For example, some propose to gather scientific data to figure out which medical approaches work best. However, some Republicans and medical providers fear this kind of analysis could take treatment choices away from doctors and patients.