Now for Health Insurance

by Lesley Politi on December 4, 2008


Editorial: Now for health insurance


01:00 AM EST on Friday, November 28, 2008




A recession might seem an odd time to offer new proposals for universal health care, but then you could have said the same sort of thing in the mid-’30s, when Social Security was introduced.

Washington has big fires to put out, and piling the cost of a national health plan on top of the financial-system bailout and soaring budget deficits would seem to create a heavy load indeed.

But the lack of a coherent universal health policy is one of our chief economic problems. It ruins lives, wastes economic resources and makes American business uncompetitive. The Detroit automakers would be in a lot better shape today were they not burdened with providing expensive, inefficient and often chaotic coverage to so many workers and retirees.

Our “system” is inefficient and inequitable beyond description, though of course health-insurance company executives and those who lobby for them like it a lot. It is lethal for many people every year, and ensures that through no fault of their own, health problems destroy the finances of throngs of citizens every year.

Thus a move toward universal health insurance ought to come in 2009, with a mandate that everyone be required to have insurance. And such travesties as refusing to cover people with pre-existing conditions must cease.

So we welcome Montana Sen. Max Baucus’s new health-care proposal. In announcing it, the Democrat made it clear that he’s offering a vision, not detailed legislation. That’s okay.

As chairman of the Senate Finance Committee, which oversees Medicare and writes tax law, Mr. Baucus will be deeply involved in any new formulations of health policy. But probably leading the way will be former Senate Democratic leader Tom Daschle, who is in line to be secretary of health and human services. Mr. Daschle, we are happy to report, is a strong proponent of universal health coverage.

Mr. Baucus’s proposal resembles that outlined by President-elect Obama during the campaign, but with one important difference. Senator Baucus would wisely require everyone to participate in health insurance. The lack of a mandate was a serious flaw in the Obama plan. It would have left the insurance pool heavy with the old and sick, as healthy young people opted out. To work well, such insurance must have as big a pool as possible.

The Baucus plan would let uninsured people age 55 to 64 buy into Medicare. It would expand Medicaid, the federal-state program for low-income Americans, and SCHIP, which covers children. Like Massachusetts’s insurance plan, this one envisions an insurance exchange that would connect uninsured people with one of several private health-plan options. Tax credits would help those deemed unable to pay part or all of the cost.

Like Mr. Obama’s plan, the exchange would include a government-run plan that could compete with the private options. All the plans would have to offer a certain level of benefits and be open to all, regardless of pre-existing medical conditions. Cheaper to just extend Medicare to everyone, but you have to start somewhere . . .

The plan touches on several needed reforms. One is to improve the payments for primary-care physicians, which would improve care and save money. Another would fix laws covering medical malpractice, which drives up the price of medical care.

The Baucus plan offers no cost estimates and suggests no ways to pay for it. That obviously will come in legislation, which we hope arrives next year.

We suspect that a national health plan will gel within the next couple of years and that some of the expiring Bush tax cuts will be used to pay for it. Those wary of an expensive new government program should recognize that Americans spend far more per capita on health care than any other nation, while leaving close to 50 million people uninsured and public-health indices among the lowest found in developed countries.

The point of this exercise is to improve care and get health-care costs under control. We have tolerated the worst health-care “system” in the developed world far too long. A recession might offer just the spur we need to start fixing it


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