House bill’s flaw

The first question Rep. Baron Hill, D-9th District, received at his Bloomington town hall meeting last September came from a man who claimed America was a country where parents have to recycle bottles to pay for their children’s health care.

He said he wanted to know if a health care reform bill would bring medical costs down.
Hill, who had just voted to pass a reform bill out of the House Energy and Commerce Committee, touted his commitment to curbing costs and told the story of a jewelry store owner in Salem, Ind., who feared he would have to drop his family’s health care coverage if costs kept rising. But he didn’t really answer the question.

“What’s in the bill is complicated, so I don’t want to go into all the details,” Hill said.

The debate on health care has been dominated by partisan prejudices and paranoia, but Democrats have tried to side step this discontent in a lousy way – by passing a health care bill quickly with too little concern for particulars.

This meant a health care bill was never going to be perfect. But in the area of cost control, the bill Hill helped vote out of the House of Representatives late last Saturday doesn’t even approach being adequate.

Health care reform should have two main goals: expanding coverage and keeping costs down. These two goals are interconnected for obvious reasons. Lowering the cost of health care increases access on its own while making it cheaper for the government to subsidize those who still can’t afford coverage.

In terms of expanding coverage, the House bill does a decent job. It would extend coverage to nearly all Americans by mandating the purchase of insurance, forcing insurance providers to compete in a health insurance exchange where they will have to cover preexisting conditions, expanding Medicaid and offering subsidies for poorer Americans.

This is expensive, but coupled with meaningful cost controls it would be worth the price.

Liberals often claim a public government insurance option, like the one included in the House bill, will lower costs. But this misconstrues the battle as a public vs. private debate. The government already pays for about half of Americans’ health care through programs like Medicare and Medicaid.

Costs in this country have risen anyway because doctors are paid on a fee- for-service basis. This means they get paid to prescribe expensive treatments regardless of necessity.

The lack of cost controls calls the financing of the House bill into question. Besides a tax increase on the rich, the bill relies on savings that will be disappointing.

The Senate may yet steer health care reform in a better direction; the Senate Finance Committee passed a bill that included a tax on the most expensive, overly exorbitant insurance plans. But if it doesn’t, a hard choice will have to be made.

Expanding health coverage is a noble goal, and it is possible that doing so now will force lawmakers to deal with costs in the future.

But that is quite a gamble.