The health care plan President Obama released yesterday is not the plan I would have written. Nor is it clear to me that releasing a plan in advance of the bipartisan health care summit on Thursday was the way to go: Better to have held the summit and then announced a plan that included significant Republican ideas. (The White House plan does include many GOP ideas and even has a web page dedicated to them!) But, whether this plan is the best plan, or whether it has a conceivable legislative path to enactment, or whether it will garner sufficient political support, important those these questions are, the most important question is this. Does the President’s plan improve upon the status quo? And, the answer to that question is yes.
The news that a large health care plan in California intends to raise premiums by almost fifty percent shows the problems with the status quo. Any individual whose employer does not provide health insurance coverage and must seek such coverage on their own can tell you all about other problems with the status quo. (When I first became a self-employed writer, I was offered health insurance through a writers’ guild at the cost of $825. per month. After I picked the phone up off the floor, I declined that coverage and did the only thing I could: I went without health insurance for three years.) Of course, those with a pre-existing condition have the most horrific tales, especially those people who have health insurance, but the company finds a technicality that permits them to dodge the coverage. Finally, there is the fact that the rising cost of health care is driving up Medicare and Medicaid expenses at such a fast rate that the long-term fiscal health of the country is endangered. That is the status quo and it is unacceptable.
Obama’s proposals also did away with some of the more ridiculous aspects of the Senate bill, such as the special Medicaid funding deal for Nebraska. The Obama proposal raises the amount of the stipends to help offset the costs of the now-mandated coverage, and that is a very important improvement over the previous Senate bill. And, it strikes a balance in terms of funding the plan, taking the Senate’s tax on so-called Cadillac plans and lowering it and the House’s idea of taxing zillionaires and re-configuring, and lowering, that. This is how compromise works and in these areas the President seems to have struck the right balance.
My principal problems with the President’s plan are that it did not embrace any of the kind of easy-to-grasp reforms we have previously advocated, such as allowing individuals to buy into the same coverage their congressman gets, nor does it appear to entail any measures likely to secure the votes of moderate Republicans like the five who voted for the jobs bill yesterday.
I know, I know. The President’s plan does not include the Stupak Amendment. I continue to prefer the Senate’s language that requires everyone using the exchanges to purchase health insurance – even those who do not get any federal subsidy – to write a separate check every month to cover the portion of their premium that goes to cover abortion. Whereas Stupak envisioned insurance companies offering riders, the Senate, and now the President’s version includes the riders within the legislation and applies not only to those getting subsidies but to everyone who purchases insurance through the exchange. As for the lack of an "opt-out" for those who do not want to pay for abortion coverage, there is no mandate because they have a choice of plans. Choose a plan that does not cover abortion and you will never have to pay for the procedure for anyone else. Indeed, one of the interesting things to watch will be how effectively Catholics can organize to insist on a variety of plans being offered that do not cover abortion. Most people do not even know if their health insurance covers abortion, but the reforms will certainly take care of that and I suspect most people will not want the coverage included in their plan.
Overall, the President’s plan is better than what we have and it is now his political task to either bring the Republicans on board or make sure that they own the status quo. I believe that over time, the deficiencies in the President’s plan, some foreseeable and some not, will be corrected, just as Social Security was improved over time to cover more people than those covered under the initial legislation. What will not be changed, however, is the idea that health care is a basic human right, an entitlement, just as the Church has taught repeatedly. That is a big and worthwhile change, something no one should walk away from lightly, and it warrants support for the President’s plan which largely achieves that heretofore elusive goal.