Commentary
President shouldn't back a proposal to weaken the health reform law
by David DurenbergerPresident Obama recently seemed to endorse a proposal from Sens. Ron Wyden, D-Ore., and Scott Brown, R-Mass., to allow states the option of moving to universal coverage without a health insurance mandate. This came at an appearance before the nation's governors at their midwinter meeting in Washington.
Republican governors generally gave it the brush-off, as did GOP House leadership. Democrats appeared to be surprised.
One can't tell whether this is simply a 2012 campaign strategy developed by the White House with help from its new health reform strategist, Paul Tewes. Or the president may be signaling, again, his willingness to consider negotiating changes in the new law -- the Affordable Care Act, or ACA -- with congressional Republicans and their allies among the governors.
In any event, the proposal, as health coverage policy, is weak tea.
States can't do systemic reform and coverage expansion without massive doses of federal money. And it is irresponsible for the feds to dole out hundreds of millions without the assurance of insurance, payment and system reform, as well as universal coverage. That's the problem with Republican proposals to use a "block grant" approach in giving Medicaid dollars to the states to do with as they will. Massachusetts has already proven that.
Some Democrats responded to the president's speech by suggesting this would open the door to states considering single payer options for payment reform -- which, of course, it would. Vermont is already headed in that direction. Maine, when it has a Democratic governor, would be right behind. Eventually, were the ACA to be repealed or weakened, the inexorable rise in health care costs would force a lot more states to adopt single payer or "Medicare for All" approaches to coverage expansion.
President Obama gave the nation a once-in-a-lifetime chance to develop a uniquely American health care system in the passage of the ACA. It is an opportunity to capitalize on the strengths of the nation, on the proven advances in health care quality improvement and cost containment that exist in some regions of the country. Compared to other developed countries, this is very much a road less traveled. The president should use his precious time to encourage the law's implementation as soon as possible in areas of the country that are already on this road -- like our own Upper Midwest -- not to coddle his political enemies.
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David Durenberger, former Republican U.S. senator from Minnesota, is senior health policy fellow at the University of St. Thomas and chairman of the National Institute of Health Policy.
Comments (2)
Our "uniquely American system" leads the industrialized world in cost, medically induced bankruptcies, foreclosures and deaths due to uninsurance. Unfortunately we don't lead in healthy outcomes for all of our trillions spent.
If The President's support of the Wyden-Brown amendment opens the door to single-payer in Vermont, followed by California, Hawaii, Colorado, Maine, Connecticut and Minnesota that will be a great thing. Universal coverage, cost containment, greater decision making in the hands of patients and providers, accountability, administrative efficiency and an END to the "uniquely American" medical debt-induced bankruptcies, foreclosures and deaths due to uninsurance.
Single-payer systems can and would incorporate payment and delivery system reforms that Sen. Durenberger suggests and would do so more efficiently because there would be one payer, one set of prices and one set of rules for processing and adjudicating claims. This would not only limit fraud and waste it would eliminate cost shifting. I recommend reading the brilliant proposal and economic projections Dr. William Hsiao presented to Vermont. The executive summary and graph of projected savings are both compelling: http://www.leg.state.vt.us/jfo/healthcare/FINAL%20REPORT%20Hsiao%20Final%20Report%20-%2017%20February%202011_3.pdf
Single-payer lowers costs, "bends the cost curve" and covers EVERYONE (not 94 or 95% as projected by the PPACA).
The health care reform has a lot of good benefits which most Americans are looking forward to enjoy. But it's the mandate that's keeping them wary about it. Obama probably figured that it would be better to make some compromise to ensure that the law is still going to be fully implemented by 2014. But if we are to fully implement all of the laws provisions, it needs the mandate to stand.
Anne C
NY Health Insurer
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