Tuesday, March 23, 2010

Healthcare Reform: The real fight is just beginning

Well, he finally did it.

After a full year of wrangling with a recalcitrant
Congress to the exclusion of almost all else, President
Barack Obama has his victory on healthcare reform.

In a strict party-line vote, this historic legislation passed
the House 219-212, with, as predicted, zero Republican

And, as George Will pointed out in today's Washington Post,
the President views this as a transformative measure, one
that will put him alongside FDR, Truman, and LBJ as a
successful Democratic President who changed the national
debate and altered the nation's course for the better.

And while in my view this bill falls short of what is needed
to truly reform the nation's system of healthcare delivery,
it's at least a start.

To begin with, it will bring the estimated 32 million
uninsured into the national "covered" pool. As I have
maintained from the beginning, unless everyone is
in the insurance pool and paying, reforms such as
banning coverage denial for pre-existing conditions
and severely restricting claim denial or lifetime caps
on coverage are just not possible. And, to make it
possible for uninsured individuals to purchase such
insurance , there will be a whole panoply of
credits, subsidies, and direct payments to make this

And that's the hard part that has yet to be tackled.

To be sure, the Republicans have been united in
opposition to all of this. True to their ideological leanings,
they have trumpeted the primacy of "the private sector"
in delivering health care to all affordably.

But the "Private Sector" is the biggest problem in all
of this. In the Health Insurance industry, the private
sector has morphed from profit-seeking to rent-seeking.
In most states, one or two companies have monopoly
or duopoly positions in both the group (employer)
and individual insurance markets. In these markets,
claim denial, coverage exclusions, and ever-smaller caps
on coverage are the order of the day. To the extent that
the health care bill tackles these problems, it's a reform
long overdue, and the Republicans are just plain wrong
about this.

But on one issue and one issue only - COST - the GOP
has found an issue that has undeniably registered
with the public.

In an age of trillion-dollar bailouts to Wall Street,
declining GDP and mass unemployment, another
980 billion dollar entitlement that has to be paid
for by either increased taxes, increased deficit
spending, or both is just not going to sit well with
the voters.

And right now, I have to count myself among the
skeptics. When it comes to entitlements, the
government's track record on cost control is not
a good one.

Right now, both Medicare and Medicaid are
approaching bankruptcy, and nowhere in this
bill do I see any realistic attempt to bring the costs
of these massive health care entitlements under

The GOP is undeniably right on just this one issue.

And that is what is going to set up the continuing
health care fight. The "amendments" to this bill
now pending in the Senate are just the start.

There will also have to be enabling legislation
to set up the bureaucracy to run this program
and give it the power to write regulations. And,
in order to meet the 2014 implementation deadline,
appropriations under this bill will have to be made
starting in Fiscal Year 2011 - and that debate will
start this fall.

That means another series of partisan fights
right up until the mid-term elections.

As I said, this fight is not over - it's just beginning.

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