The big health care change

A few months ago, the IU College Democrats held a meeting the day after then-State Sen. Scott Brown, R-Mass., defeated Massachusetts Attorney General Martha Coakley in the Massachusetts special election for U.S. Senate.

They discussed with disappointment the election of a senator who took away the Democrats’ filibuster-proof majority. At the IU College Republicans’ callout meeting, Brown was taken as a sign that another Republican revolution was on the horizon and that Democratic plans for health care reform were on their last leg.

The mood at the College Republicans meeting the Monday after the House of Representatives sent the Senate version of the health care bill to President Obama’s desk was comparable to the frustration and disillusionment liberals often felt when George W. Bush was in the White House.

There was a sense that history was going rapidly off-course and that someone needed to do something about it.

But history marches on.

Republicans might run against this reform, but even if they sweep the 2010 midterm elections, it’s unlikely the new health care legislation will ever see a blanket repeal.

Obama has signed a bill that will redefine health care in America. It does a reasonably good job of expanding access to insurance, achieving something close to universal coverage, but the bill does a poor job of controlling costs. The real legacy of health care reform will be decided by how future politicians deal with that deficiency.

The move to universal coverage comes with significant costs. Billions will be spent on subsidies and an expansion of Medicaid. Those subsides also create a powerful disincentive among the poorest to increase their incomes.

But with the price comes an assurance of minimum standards of care for everyone, and most other developed countries, some more successfully than others, have shown that a trade-off between higher taxes and more equality in health care can be quite reasonable.

Conservatives often make their arguments against expanding coverage by exaggerating the costs of doing so, but if expanding coverage is going to be a goal, then we have to pay for it.

Nevertheless, we could be getting a better deal if health care reform had lived up to its potential to control costs. Some Democrats balk at the claim that this bill doesn’t go far enough. The bill includes an excise tax on more expensive health care plans that will help reduce overconsumption and there is the promise of future Medicare cuts.

The plan also includes an independent payment-advisory board on Medicare spending. Given the size of Medicare, any successful efforts to make Medicare spending more efficient would likely spread across the insurance industry.

These are good first steps, but they are not enough. The excise tax and Medicare cuts are unpopular promises that might be constantly deferred into the future — in part because Republicans seem even less likely than Democrats to take the right stand on them.

The payment-advisory board faces limits on the recommendations it can make, and it will ultimately fall to Congress to follow up on them.

This legislation seems to wrap up action on the health care for the time being, but the issue will be back again soon.


E-mail: nrdixon@indiana.edu