Tuesday, August 11, 2009

Health Care Reform and Me - My Verdict - NO

H.R. 3200 America's Affordable Health Choices Act of 2009 would increase the federal deficit by $239 Billion, as introduced and over a timespan of 2010-2019 per the Congressional Budget Office. The Joint Committee on Taxation has offered an amendments to their original costing estimates, which can be found at their site. The original submission of the Revenue Provisions of the act is also at the JCT site, and runs to 52 pages.

H.R. 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act has not been scored by the Congressional Budget Office. So we don't really know what it will cost, not even an estimate by Congress' own scoring office, and we have vague claims that it will save us money overall.

Back in 2006, H. Edward Hanway, the CEO of Cigna, brought home a cool $12M in compensation, and that was before any stock options kicked in. He got a bunch more in 2007. It dropped by 50% in 2008 but was still a multi-million figure. This guy is not worried about paying his health care bills. Without a doubt health insurance premiums helped to pay for his compensation. All those millions could have gone elsewhere, such as reduced premiums or expanded benefits.

The salary paid to Hanway is nothing new, you can look back to 1996 and see the outrageous compensation even then. One of the arguments for health care reform is that the insurance companies' overhead is excessive, and by eliminating it (H.R. 676) or finding ways to manage it (H.R. 3200) we'll all be better off. Then there are the stories of people cut off from insurance, denied insurance or unable to afford insurance that suggest we still are not willing to be our brother's keeper. Health care reform in either version would presumably ensure everyone gets taken care of.

From the perspective of pure moral justice, no one should be denied health care or provided substandard care simply because they lack money. That is not how we should take care of each other. At the same time, we cannot allow ourselves to be pulled into a situation where the irresponsible among us assume a sense of entitlement but no sense of responsibility for themselves let alone their own actions or lack of action. None of us has a bottomless pit of money that allows us to play Good Samaritan day after day. We do the best we can with what we have and, unfortunately we have less every day. What is a thoughtful, caring citizen to do?

H.R. 3200 is not the answer. Well intentioned though it may be, and even though I think it has some decent provisions, it is a disaster in the making. It is expensive, it includes the kitchen sink, it is a sop to any and all with an ax to grind (except those in the single payer camp), it creates a new bureaucracy, and it attempts to do everything. It may in fact do everything but I suspect it will then become the "jack" of health care but master of none of it. If this bill is enacted you can expect we'll be back on the Hill arguing over its piece parts in the future. I don't believe health care costs will go down if this bill is enacted, they will likely go up, although the politicians will employ the usual sleight of hand to tell us otherwise.

H.R. 676 is not the answer, yet. Its sponsors must do a better job explaining the funding for and the savings from enactment of this bill. Right now the funding looks lopsided and the claimed savings aren't even identified clearly. This bill would increase the responsibilities of Medicare, and presumably the bureaucracy to manage it. Issues around current practices and reimbursement for services are unlikely to go away and may be exacerbated. All the same, Medicare is an important option for many elderly, including members of my extended family. Sometimes it's the only option. It's there and it does pay.

I suspect single payer is the way to go, however the manner of funding for H.R. 676 and its alleged savings need more work.

The bottom line is that Congress needs to get back to work and fix the problems of H.R. 676 and toss H.R. 3200 out the window, or simply start over from scratch. Congresswoman Schakowsky, and the President, will hear from me on that.

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