Fum­bled bill

While health re­form passed, mod­i­fi­ca­tions likely

Modern Healthcare - - Healthcare Opinion Leaders Survey -

While I have pro­found dis­agree­ment with what Pres­i­dent Barack Obama and the Demo­cratic con­gres­sional lead­er­ship did with pas­sage of the Pa­tient Pro­tec­tion and Af­ford­able Care Act, their mo­ment of ju­bi­lance is un­der­stand­able. It was a sig­nif­i­cant leg­isla­tive ac­com­plish­ment.

I, too, ad­vo­cated large-scale re­form of our na­tion’s health­care sec­tor. Were the out­come mine to choose, how­ever, re­form would have fo­cused on the real prob­lem: cost. Solv­ing the cost prob­lem paves the way for ex­pan­sion of cov­er­age to fol­low.

Ad­vo­cates of the new law say once ev­ery­body is in­sured, we can be­gin deal­ing with the cost of care. Count me as skep­ti­cal on this one. Their as­sumed 10-year es­ti­mates sug­gest that half the funds needed for health re­form will be se­cured by re­duc­ing Medi­care growth by a halftril­lion dol­lars. This will not hap­pen—it never does. I have per­sonal ex­pe­ri­ence in this cat­e­gory. As HHS sec­re­tary, I an­nu­ally de­liv­ered bud­gets to Congress that con­tained a mere frac­tion of the Medi­care re­duc­tions that this law now de­mands. Th­ese pro­pos­als were met with ve­he­ment op­po­si­tion from mem­bers of Congress, in­clud­ing claims that I lacked com­pas­sion and com­mon sense. If a Demo­cratic-con­trolled Congress wasn’t will­ing to make the hard de­ci­sions when the cuts were much smaller, why would the out­come be dif­fer­ent now?

Here is the re­al­ity. Half the fund­ing for the health re­form bill will come from new taxes and the rest will be added to the na­tional credit card for the next gen­er­a­tion to pay. The buy-to­day, pay-to­mor­row men­tal­ity is a time-hon­ored con­gres­sional tra­di­tion, es­pe­cially when it comes to health en­ti­tle­ments. Putting it on the next gen­er­a­tion’s credit card is an all-too-fa­mil­iar sce­nario.

I agree that pre-ex­ist­ing con­di­tions should be elim­i­nated from the is­suance of health in­sur­ance. How­ever, there are smarter ways to do it. The act will pro­duce un­in­tended con­se­quences galore. Ac­tu­ally, I’m not sure the con­se­quences are un­in­tended. It may be more ac­cu­rate to call them undis­cussed con­se­quences.

With the com­bi­na­tion of pre-ex­ist­ing con­di­tions, med­i­cal-loss ra­tio, com­mu­nity rat­ing and weak in­di­vid­ual man­dates, the health re­form bill has guar­an­teed an exit of cap­i­tal from the health in­sur­ance busi­ness. Their leg­isla­tive lan­guage, in com­bi­na­tion with the pop­ulist rhetoric against any­thing re­sem­bling cap­i­tal­ism, causes me to won­der if there was any­thing un­in­tended about it. The act was drafted by leg­is­la­tors who openly ad­vo­cate for the gov­ern­ment be­com­ing the in­sur­ance sys­tem, and if the bill is im­ple­mented, as passed, they will suc­ceed.

An­other as­pi­ra­tion I share with drafters of the health re­form bill is for ev­ery Amer­i­can to have ac­cess to af­ford­able in­sur­ance. How­ever, the new leg­is­la­tion con­tem­plates a dif­fer­ent role for gov­ern­ment than I en­vi­sion.

Gov­ern­ment’s role should be lim­ited to or­ga­niz­ing, not own­ing, the health­care sys­tem.

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