Health Care for All? Not Exactly
Walter Shapiro
Senior Correspondent
Posted:
10/15/09
In late January 2007, fledgling presidential contender Barack Obama made an unequivocal pledge to redeem the dream that had animated Democrats since the days of Harry Truman. Speaking at a Washington conference organized by the liberal advocacy group Families USA, Obama declared, "I am absolutely determined that by the end of the first term of the next president we should have universal health care in this country."
Two weeks later, as he formally declared his candidacy, Obama repeated that promise virtually word-for-word. There were no hedge phrases about winning 60 votes in the Senate, four-year phase-in periods or limiting the total 10-year price tag to a maximum of $900 billion. On that frigid Saturday morning in Springfield, Ill., Obama uttered the magic words that liberals craved: "health care for all."
Following Tuesday's vote in the Senate Finance Committee and the headline-making support of moderate Republican Olympia Snowe, health care reform is closer to congressional passage than it ever was under Bill Clinton. Still ahead is intense Senate-House bargaining that will test the endurance of even veteran hostage negotiators. But the expectation is that the final legislation will reflect the contours of the bill cobbled together by Senate Finance Committee Chairman Max Baucus.
Many liberals are not satisfied with the Finance Committee's bill, but most of their ire has been directed at the failure of Baucus and Company to include a government-run health care plan (the so-called "public option") in the legislation to compete with private insurers. The high-decibel dispute over the public option has far more to do with ideology than it does with universal coverage, since a government-run plan is not needed to provide Americans with health coverage. What matters in terms of coverage is guaranteeing that all Americans can afford to purchase adequate health insurance.
Lost in the rhetorical shouting match over the public option is the true deficiency of the Senate Finance Committee bill. That legislation contains laudable elements, but – make no mistake – it is not "health care for all."
An estimated 16 million Americans and another 8 million illegal immigrants would still lack coverage in 2015 under the Baucus bill, according to an analysis by the Congressional Budget Office. Those 24 million people -- roughly equal to the population of Texas -- would be forced to depend on hospital emergency rooms and charity for their meager health care coverage. For those who prefer to pretend that illegal immigrants do not exist, that would still leave 16 million Americans (picture the population of Florida) with no medical safety net.
The House version of the health care bill, which has been approved by three committees but not yet debated on the floor, would come significantly closer to guaranteeing universal health care. According to the CBO, the House bill would cover everyone except for 9 million Americans and, once again, those 8 million illegal immigrants.
(This congressional obsession with excluding illegal immigrants from the health care system is a bit bizarre since it assumes that American citizens only catch diseases from other citizens. Luckily, illegal immigrants tend to work in hermetically sealed conditions in jobs like picking crops, washing dishes in restaurants and caring for young children.)
The discrepancy between the House and Senate health care bills can be explained with a single number: $353 billion. That is the projected 10-year difference in cost between the two pieces of legislation – and mostly it dictates the differences in coverage rates. The House bill would cover by 2015 97 percent of all legal residents with a 10-year cost of $1.182 trillion. The slimmer Senate Finance Committee legislation comes with a price tag of $829 billion and would in 2015 achieve a coverage rate for Americans of 94 percent.
As Karen Pollitz, a professor at Georgetown University's Health Policy Institute, explains, "How do you get above 94 percent coverage? You spend more money. It's not rocket science." Mostly, the additional funds would go to increase the subsidies for hard-pressed Americans who do not get health insurance through their jobs but who cannot afford to buy it from insurance companies.
The underlying problem is that there is the lack of the political will in the Senate and the White House to spend enough money on subsidies to come close to achieving universal coverage. With Barack Obama publicly embracing a 10-year cost figure of $900 billion, and the White House worried about the political repercussions from a trillion-dollar price tag, the possibilities for maneuvering are limited. The central issue is not the deficit, since both pieces of legislation pay for themselves with new taxes and reductions in other types of federal health care spending. Rather, the difficulty is rooted in the politics of assembling a 60-vote filibuster-proof Senate majority and the atmospherics of appearing to contain health care spending in the midst of record red ink budgets.
Nancy LeaMond, an executive vice president of AARP, likened the coming collision on Capitol Hill over the final shape of the health care bill to roller derby -- fast-paced with elbows and knees flying. It is an apt metaphor with every lobbyist and special pleader in Washington wanting to get pet provisions into the legislation. (The AARP, which actively supports health care reform, wants the legislation to quickly eliminate the requirement that Medicare recipients should absorb a significant fraction of the costs under the prescription drug benefit.)
The risk is that expanding coverage rates will get lost in the shuffle. There are theoretically funds available, since the Senate bill comes in at $71 billion less than Obama's self-imposed ceiling. Also, there might be a way of combining the funding mechanism in the House bill, a so-called millionaire's tax, with the Senate bill's levy on gilt-edged insurance plans. If another $100-$150 billion were somehow added to the Senate bill, it would be possible to achieve something acceptably close to universal coverage.
There is no doubt that the Senate Finance Committee bill -- even if unmodified -- would be a major step on the road to reforming health care. According to the CBO, 27 million more Americans would have coverage in 2015 under the Senate bill compared to maintaining the status quo. Liberals also learned from Clinton's 1994 health care debacle the dangers of resisting compromise in the name of doctrinal purity. As Bill Galston, a former domestic policy advisor in the Clinton White House who is now a fellow at the Brooking Institution, puts it, "Democrats on health care have been like the Palestinians on peace. They never missed an opportunity to miss an opportunity."
But the political promise voiced by Barack Obama and virtually every leading figure in the Democratic Party has been "universal health care." Without entering the realm of cloud castles and political fantasies -- without ignoring the gimlet-eyed realities of getting a health care bill through the Senate -- it is still possible in the weeks ahead to make sure that this landmark legislation covers more Americans who cannot afford to visit a doctor.
Two weeks later, as he formally declared his candidacy, Obama repeated that promise virtually word-for-word. There were no hedge phrases about winning 60 votes in the Senate, four-year phase-in periods or limiting the total 10-year price tag to a maximum of $900 billion. On that frigid Saturday morning in Springfield, Ill., Obama uttered the magic words that liberals craved: "health care for all."Following Tuesday's vote in the Senate Finance Committee and the headline-making support of moderate Republican Olympia Snowe, health care reform is closer to congressional passage than it ever was under Bill Clinton. Still ahead is intense Senate-House bargaining that will test the endurance of even veteran hostage negotiators. But the expectation is that the final legislation will reflect the contours of the bill cobbled together by Senate Finance Committee Chairman Max Baucus.
Many liberals are not satisfied with the Finance Committee's bill, but most of their ire has been directed at the failure of Baucus and Company to include a government-run health care plan (the so-called "public option") in the legislation to compete with private insurers. The high-decibel dispute over the public option has far more to do with ideology than it does with universal coverage, since a government-run plan is not needed to provide Americans with health coverage. What matters in terms of coverage is guaranteeing that all Americans can afford to purchase adequate health insurance.
Lost in the rhetorical shouting match over the public option is the true deficiency of the Senate Finance Committee bill. That legislation contains laudable elements, but – make no mistake – it is not "health care for all."
An estimated 16 million Americans and another 8 million illegal immigrants would still lack coverage in 2015 under the Baucus bill, according to an analysis by the Congressional Budget Office. Those 24 million people -- roughly equal to the population of Texas -- would be forced to depend on hospital emergency rooms and charity for their meager health care coverage. For those who prefer to pretend that illegal immigrants do not exist, that would still leave 16 million Americans (picture the population of Florida) with no medical safety net.
The House version of the health care bill, which has been approved by three committees but not yet debated on the floor, would come significantly closer to guaranteeing universal health care. According to the CBO, the House bill would cover everyone except for 9 million Americans and, once again, those 8 million illegal immigrants.
(This congressional obsession with excluding illegal immigrants from the health care system is a bit bizarre since it assumes that American citizens only catch diseases from other citizens. Luckily, illegal immigrants tend to work in hermetically sealed conditions in jobs like picking crops, washing dishes in restaurants and caring for young children.)
The discrepancy between the House and Senate health care bills can be explained with a single number: $353 billion. That is the projected 10-year difference in cost between the two pieces of legislation – and mostly it dictates the differences in coverage rates. The House bill would cover by 2015 97 percent of all legal residents with a 10-year cost of $1.182 trillion. The slimmer Senate Finance Committee legislation comes with a price tag of $829 billion and would in 2015 achieve a coverage rate for Americans of 94 percent.
As Karen Pollitz, a professor at Georgetown University's Health Policy Institute, explains, "How do you get above 94 percent coverage? You spend more money. It's not rocket science." Mostly, the additional funds would go to increase the subsidies for hard-pressed Americans who do not get health insurance through their jobs but who cannot afford to buy it from insurance companies.
The underlying problem is that there is the lack of the political will in the Senate and the White House to spend enough money on subsidies to come close to achieving universal coverage. With Barack Obama publicly embracing a 10-year cost figure of $900 billion, and the White House worried about the political repercussions from a trillion-dollar price tag, the possibilities for maneuvering are limited. The central issue is not the deficit, since both pieces of legislation pay for themselves with new taxes and reductions in other types of federal health care spending. Rather, the difficulty is rooted in the politics of assembling a 60-vote filibuster-proof Senate majority and the atmospherics of appearing to contain health care spending in the midst of record red ink budgets.
Nancy LeaMond, an executive vice president of AARP, likened the coming collision on Capitol Hill over the final shape of the health care bill to roller derby -- fast-paced with elbows and knees flying. It is an apt metaphor with every lobbyist and special pleader in Washington wanting to get pet provisions into the legislation. (The AARP, which actively supports health care reform, wants the legislation to quickly eliminate the requirement that Medicare recipients should absorb a significant fraction of the costs under the prescription drug benefit.)
The risk is that expanding coverage rates will get lost in the shuffle. There are theoretically funds available, since the Senate bill comes in at $71 billion less than Obama's self-imposed ceiling. Also, there might be a way of combining the funding mechanism in the House bill, a so-called millionaire's tax, with the Senate bill's levy on gilt-edged insurance plans. If another $100-$150 billion were somehow added to the Senate bill, it would be possible to achieve something acceptably close to universal coverage.
There is no doubt that the Senate Finance Committee bill -- even if unmodified -- would be a major step on the road to reforming health care. According to the CBO, 27 million more Americans would have coverage in 2015 under the Senate bill compared to maintaining the status quo. Liberals also learned from Clinton's 1994 health care debacle the dangers of resisting compromise in the name of doctrinal purity. As Bill Galston, a former domestic policy advisor in the Clinton White House who is now a fellow at the Brooking Institution, puts it, "Democrats on health care have been like the Palestinians on peace. They never missed an opportunity to miss an opportunity."
But the political promise voiced by Barack Obama and virtually every leading figure in the Democratic Party has been "universal health care." Without entering the realm of cloud castles and political fantasies -- without ignoring the gimlet-eyed realities of getting a health care bill through the Senate -- it is still possible in the weeks ahead to make sure that this landmark legislation covers more Americans who cannot afford to visit a doctor.