The Health Care Reform Bill

Caveat: I don't have time to research H.R. 3200, the House version of this bill, or any of the others, completely; so this analysis is based on reading the summary, scanning the text, and commentary from other sources. My analysis may have major holes in it. However, a conservative friend asked me to comment on it, so I'll give it a try.

First, this bill is almost 500 pages long. A basic principle I like to go by, articulated by Albert Einstein, is, "Everything should be made as simples as possible – but not simpler." Clearly, this bill fails that simple test.

The bill does have a lot of good points. It eliminates exclusions for pre-existing conditions. It limits out-of-pocket expenses and doesn't limit payouts. It covers preventive services. It provides health insurance for everyone. It requires the rich to pay more than the poor and middle class. It guarantees coverage for everyone. It includes mental health services. And so on.

My objections are as follows:

1. It's way more complex than it has to be. (See comment above.) It establishes a new bureaucracy, the "Health Choices Administration," with additional layers such as the "Health Insurance Exchange." It establishes a new public health insurance provider within this, I think as part of the Exchange. In addition, it seeks to fill the prescription benefit hole with this new insurance, so that people covered by Medicare then have the additional complexity of multiple payers for the same product, essentially doubling the paperwork. Every one of those is completely unnecessary and redundant. We've already got two public plans, Medicare and Medicaid, which is one more than we should have. Medicare has its problems, but it is run very efficiently. In fact, providing insurance is one of those places where government can excel, exceeding the efficiencies and effectiveness of private insurance because it is not motivated by profit, but by service.

2. The Health Insurance Exchange is supposed to compete with private insurers. Big mistake. I'd rather see something like the old-age insurance (Social Security) system: it is available for all, and if you want supplemental financial planning services, go for it.

3. It requires employers to provide coverage, based on payroll, not profitability. Really bad idea. We should be divorcing employers from providing coverage, not requiring more. Almost all other developed nations (those with which we trade) have single payer public health insurance; employers in those nations don't have the added cost of providing coverage. It's just one stupid way to make our own industry less competitive on the global market. Besides, it can really hit small employers hard, especially if their payroll is bigger than their profit. Expect marginal businesses to go under.

4. It doesn't mention "medically necessary." It should. Any procedure, service, or product considered medically necessary should be covered. That includes Sex Reassignment Surgery.

5. It imposes a tax on individuals without a health plan. That's okay, but I'd rather see a single-payer system that basically taxes everyone.

6. If it is true that people will be fined if they don't purchase a health care package, that is a major objection. "Nothing of benefit to the individual is obtained through coercion." (Socrates, I think?) I can think of no way to increase resistance to this bill better than this. People hate coercion, and rightfully so. I hate it. "Give me liberty, or give me death!"

7. Cost is not adequately addressed. (See update and link to Field's post below.) Without giving the public health insurance entity full ability to negotiate prices and without limiting the extent of malpractice suit penalties, cost cannot be adequately addressed. And creating redundant public bureaucracies adds a completely unnecessary level of cost, just for administration. It's stupid and counter-productive.

This health care reform bill is nowhere near as bad as some of the conservative commentary I've seen on it. For instance, one such objection is that it rations your health care. This exhibits the privileged ignorance of those who make this objection. Health care is already rationed, usually by income level. Poor people often have no coverage. Trans people can't obtain medically necessary procedures that are available to others. In fact, private insurers ration by pre-existing condition, exclusions, maximum payouts, preferred provider networks, and every other means they can legally access. This bill may well ration health care, but by eliminating maximum payouts, pre-existing conditions, and income refusals, it significantly reduces existing rationing. Another objection is that a government committee will determine your treatments and benefits. So what? Under private care, you've got an insurance executive, whose paycheck depends on reducing benefits provided to you, making those choices. And guess which one can be held accountable? (Hint: it's not the executive.) Making things better does not necessarily constitute making things perfect, but that's no reason not to do it.

Going back to Einstein's quote, the solution to the health care mess is way simpler than this bill. All we need to do is make Medicare available to everyone, with the following reforms: a) require it to negotiate prices. b) simplify the paperwork – everyone is covered, every provider a preferred provider; list the products and services provided to the patient on one sheet of paper, submit for payment, and you're done. c) limit malpractice suit payouts. d) cover alternative systems, such as acupuncture, naturopaths, homeopathy, and Christian Science treatment. Medicare is an efficiently run, existing agency; expanding it is simple, efficient, and effective. You could fit a far more complete reform package into a 25- or 50-page bill.

In sum, this bill is nowhere near as bad as the conservatives would make it out to be. It's also nowhere near as good as some liberals are making it out to be. It has some major problems, but also some really good stuff. Having looked at the actual bill, however briefly, I've modified my opposition. I'm agnostic. It will make some things better, but it will also create new problems which are obvious and predictable, and leaves other problems unaddressed. Whether there is a net social benefit to the bill is unclear to me – there may be one, and there may not. If it passes, we'll just have to wait and see.

One thing is clear, however: This health care reform bill could be a hell of a lot better.

Update: Field Negro is one smart cookie. When he posts something like this, I tend to believe it - and I agree with his commentary, especially about having each other's backs.