Another False-Start on Health Care Reform?
The health care system in the United States is in a state that has just about everyone aching for reform. Spending on health care now absorbs 16% of the gross domestic product (GDP) of the largest economy in the world, a share that will reach 20% in 2017. And while it’s become a cliché to say that America offers the best health care in the world, no one seems very satisfied that we’re getting sufficient bang for our $2.3 trillion bucks. On top of that, 46 million people in America (more than 15% of the population) don’t have medical insurance. And millions more are “under-insured,” i.e., lacking sufficient coverage to keep their out-of-pocket medical expenses manageable. And we all know that “cost shifting” means that the uninsured problem is a significant factor driving up medical costs … which, in turn, drives up the cost of health insurance … which, in turn, drives up the number of uninsured. A vicious cycle that is unsustainable … for individuals, employers, and government.
So fixing health care has emerged as the poster child for “reform you can believe in,” and President Obama and Congressional leaders have pretty much anointed comprehensive health care reform as this year’s preeminent domestic policy issue. But “reform you can believe in” means different things to different “stakeholders,” and getting enough of them to agree on a single reform approach is no small matter.
Up to this point, the months-long effort to do that has been centered in the United States Senate and its Finance Committee under the leadership of its Chairman and Ranking Minority Member, Senators Max Baucus (D-MT) and Chuck Grassley (R-IA) respectively, and its Health, Education, Labor, and Pensions (HELP) Committee under the leadership of its Chairman, Senator Edward Kennedy (D-MA) and Ranking Minority Member, Senator Mike Enzi (R-WY). Business has been sitting at the table along with unions, senior citizen and consumer groups, insurers and the medical community.
Sooner or later, if the process is to have any chance of bearing fruit, the conversation must be brought to a conclusion, difficult decisions on complex and controversial issues must be made, a bill must be produced, and lawmakers must vote and subject themselves to political accountability for the choices they make. That time is about here: both the Finance and HELP Committees are expected to “mark-up” comprehensive bills this month, followed by an effort to merge the two versions into one bill for consideration by the full Senate in July.
(The House of Representatives is operating on a similar time line for producing and passing a bill. However, the process in the House is neither collaborative nor bipartisan. The Democrats, with their decisive committee majorities and nearly 80-seat advantage in the House are likely to move a health care bill to the floor and out of the House with little if any GOP input or support.)
While the Senate Finance Committee has yet to produce a legislative draft and language is just now seeping out of the HELP Committee, a pretty good idea of where key Senate Democrats are heading is taking shape. Regrettably, the picture ain’t pretty. Given that whatever bill the Senate produces … assuming it passes one at all … is virtually certain to be the “high water mark” for employers and those who want to emphasize a free market approach to problems in our health care system, the situation as it is developing calls into question how much longer free market advocates can remain part of this “collaboration.”
Throughout this process President Obama had left the details of health care reform legislation to the Hill while continuing to beat the drum publicly for comprehensive reform. More recently, however, the President has taken a more visible role on specifics, wading in on some of the more controversial issues in play in this debate. To put it mildly, what the President has had to say about an employer mandate, a public plan option, and the tax exclusion moves the needle clearly in the wrong direction. More broadly, the President’s newly-minted “two-cents worth” has added to the appearance of a process that now has little if anything in it by way of cost control, for employers.
Comprehensive health care reform is needed … the current system is simply neither desirable nor sustainable. Wholesaler-distributors, the vast majority of who – upwards of 90% in our surveys – offer employer-paid health benefits to their workers, understand this. NAW has and will continue to work on comprehensive health care reform with our allies in the employer community and with policy makers on both sides of the political aisle. However, NAW members have told us they do not support a public plan option to “compete” with private health plans. Neither do wholesaler-distributors support an employer “pay or play” mandate or taxing themselves (employer share of payroll taxes) or their workers on employer-paid health benefits. As always, NAW intends to be a vigorous advocate for our members in this debate. Regrettably, despite the promise with which the employer community once viewed health care reform, it is increasingly looking like NAW … and other similarly-minded employer groups and their member companies … will have to step back from a futile attempt to shape an increasingly bad bill and turn our attention to its defeat.
“Clinton-Care” the sequel? As Yogi Berra once famously remarked, it’s “déjà-vu all over again.”