This is a critical summer for the United States, its economy, its people, and the way that health care is delivered in our country. I have no doubt you are struggling with a great deal of pressure from all sides in the rush to make something happen this summer. Some are terrified at the prospect of a government growing beyond its classic role while others are terrified that they or a loved one will go without critical health care.
I can understand both sides. For a number of years I’ve dealt with medical conditions that would make it difficult and expensive for me to buy health insurance on the open market if my employer didn’t provide insurance. In addition, I know from first hand experience that the strain of medical issues can push a person into bankruptcy.
So I can truly sympathize with those who are hurting and those who worry about their future care; however, I cannot agree that we need to turn our economy upside down and embark on what will essentially become a government-run health care system. I say this knowing full well that one day I may not be able to get health insurance because of pre-existing conditions; nevertheless, I recognize there are things of greater importance than the challenges I might personally face down the road.
I hope that you will help hold the line this summer and fall, opposing efforts to pass legislation this year, particularly a public option. I hope that you will help cooler heads prevail so that we can spend the coming months beginning to talk about truly innovative ideas to improve access to health care while not discarding what is great about health care in America. I hope you can work with and lead fellow congressmen in the next year to craft a plan to systematically tackle health care problems faced by so many.
Instead of health care reform this year we need to craft a “plan to succeed” in the future. With that in mind I want to offer some additional reasons for delaying action this year. I believe these reasons are firmly grounded in common sense, not the rhetoric of the right or left.
The Uninsured
For years we have heard the mantra “46 million uninsured,” but that number doesn’t tell the whole story. Now I don’t have a legislative staff to verify my statistics, but I believe the numbers below – pulled from a hodgepodge of sources – to be ballpark. Consider the following:
- Citizens – There are reports that 21% of those without insurance (about 9.7 million) are not US Citizens and perhaps many are illegal aliens. So one could argue the number should be closer to 36 million.
- Household Income – Approximately 17 million of those uninsured live in households with incomes exceeding $50,000. Of those, 7 million have incomes of $75,000 or more.
- Who is left? – That leaves about 20 million or so uninsured – some for only short periods of time and some I believe receive health care though Medicare or Medicaid.
- The Insured – In contrast more than 240 million Americans have insurance and they frequently express great satisfaction. Do we really need to reinvent the wheel for a relatively small percentage of the total population?
The point being that we are talking about turning over approximately 17% of the economy and practically the entire health care industry to the Federal Government — not to help 46 million Americans, but a number that is notably smaller and a fraction of the 240 million with health care coverage.
The Bigger Picture – Social Security, Medicare, and Medicaid
In my many years of following politics there has been one constant: We need to fix Social Security, but time after time choose to tweak it around the edges instead just to keep in solvent for another 20 or 30 years. In addition, Medicare is broken with patients frequently turned away from providers who won’t accept it while other providers (hospitals, doctors, etc) frequently bemoan reimbursement rates that force providers to make up the difference by charging private payers/insured more.
It seems to me that we need to first address the problems with Social Security, Medicare, and Medicaid before embarking on an expansion of government that could dwarf all three of those programs down the road.
Think of it another way: You own a home and the roof is leaking, the plumbing constantly backs up, and HVAC is on the fritz. What would you do? Take the time and money to study and fix those problems carefully or put them off to the side while you build a new addition on the cheap because money is tight.
It just doesn’t make good common sense to take such drastic steps on health care this summer – an in such a frenzied fashion – when there are other problems that have been begging for solutions for years. Furthermore, any health reforms will need to co-exist, complement or replace parts of the programs above. You can’t do it in a few months on the Hill.
Building Consensus & A Divided Public
The Founding Fathers made the Constitution exceptionally difficult to change for a number of reasons. Among them was a desire to ensure real consensus among Americans when fundamental changes to our government were envisioned. When such consensus is achieved it suggests that an issue has been thoroughly vetted by our political leaders and the common man. In addition, it increases the likelihood that Americans will pull together to support the change once it is made.
We can debate the Constitutionality of the competing plans being bandied this summer. We can even debate the Constitutionality of the Federal Government requiring a private citizen to buy health insurance – a service – on fear of penalty. This really gets under my skin because it is such a blatant intrusion upon my liberty. I understand requiring someone to buy auto insurance as a condition to drive a car, but requiring someone to buy health insurance as a condition of living & breathing as an American seems un-American to me.
These Constitutional questions aside, I believe the wisdom of securing real consensus across party lines, across socio-economic backgrounds, across race, etc is just as valid when one contemplates the health care reforms that have been proposed in recent weeks.
The proposed plans are so far reaching that their impact on the daily lives of Americans, the power of the Federal Government, and the limits on individual liberty are such that it would be premature to them pass on party-line votes reflective of a divided country on the issue. It just seems imprudent to enact such fundamental change without real consensus and to do so not for the benefit of the 250+ million who have health care coverage, but solely for a population numbering around 20 million or so.
A People Divided – Evidence America Isn’t Ready for a Government Solution
- Insured/Uninsured – Approximately 240 million have health insurance; 20 million or so do not. Each population has competing and conflicting interest in reform. The plans now being considered seem to favor the interests of the uninsured over the presently insured.
- ABC News/Washington Post poll reveals that 83 percent are very or somewhat satisfied with the quality of their care. The leading proposals will undo the very systems these people have come to trust.
- Faith in the President – President Obama’s approval rating on health care has dropped to 49% despite this being the signature issue he campaigned upon. That doesn’t scream consensus for a plan that will be forced upon perhaps half the country or more against their wishes.
- Public Plan – ABC News/Washington Post poll reveals only 37% support a private plan that puts private insurers at risk – and let’s face it, any private plan will be a lethal threat to private plans (see discussion below).
- Change in Quality – ABC News/Washington Post poll reveals that 58% don’t believe President Obama’s pledge that reform will not hurt people’s current coverage.
- Forced Coverage – ABC News/Washington Post poll reveals a 49-47 split on requiring every citizen to buy health insurance under penalty of law.
- What if it Fails – ABC News/Washington Post poll reveals that 8 in 10 fear that proposed reforms of the magnitude proposed will reduce the quality, choice, and coverage of care while increasing costs, government bureaucracy and the deficit.
- Support Among Democrats/Independents – Support for a public plan drops to 26% if private insurers can’t effectively compete with a private plan.
- Redistribution of Wealth – Leading proposals to fund the system include hundreds of billions in taxes on the wealthy, including taxes on premium health insurance plans. 70% oppose taxing benefits worth over $17,000 a year (ABC News).
- This fosters an us vs. them attitude.
- It also gives the majority (lower & middle income) the power to confiscate property of the minority (wealthy) via Congress.
- It also brings to mind “Joe the Plumber” who really struck a cord with many Americans.
A Public Plan – The Non-Starter
President Obama campaigned on being a different kind of leader. One who would reach across the aisles to find common ground. One who seemingly wouldn’t force a historic expansion of government through on a party-line vote. What happened to that candidate? The leading plans in Congress focus on a public plan that will never get bipartisan support – and they shouldn’t – so why are we spinning our wheels debating them.
The Public Plan is a disaster waiting to happen. The looming failure is based not on ideology, but common sense. The odds that it would work are astronomical. The reasons it will fail are obvious:
- A Public Plan could easily become a high-risk insurance pool that will become a financial black hole that will never pay for itself.
- There will be so much pressure in the first years to make the Public Plan attractive & successful that it will easily undercut private insurance plans with either artificially cheap rates due to taxes to subsidize the public plan or unusually generous benefits early on.
- As a result:
- Tens of thousands of businesses will decide to either – 1) pay reduced rates by moving employees to the public plan, or 2) decide to cut health coverage entirely and pay less costly federal penalties.
- At least one Congressional proposal would only penalize businesses about $750 annually for each employee who doesn’t get health care. You can’t tell me there won’t be a stampede of businesses rushing to drop coverage in the first five years and willingly pay that penalty.
- Remember Medicare Part D? – Many businesses dropped their private coverage, dumping retirees into Part D while other businesses kept their private coverage because the government offered to subsidize that coverage to keep it private.
- The Public Plan will depress payments to providers (similar to Medicare) and as a result providers will shift costs to private plans, making private plans more expensive. As the cost of private plans increases, more individuals and businesses will be pushed into the Public Plan. It creates a self-perpetuating cycle that will spell the end of private plans for all but the very wealthy.
Finally, the Public Plan option is the lazy way to reform. It is a short cut attempt to achieve universal or near universal coverage and weren’t we taught in elementary school not to take short cuts? We require more innovative ideals. Some will say the private markets have failed, but have they? Polls repeatedly show that the majority of Americans are happy with their coverage, despite some concerns about cost.
Tell me this, really, what have we done on a federal level to try to fundamentally reform and improve the private market over the past 20 years? Nothing. The states have tinkered with Medicaid and mandates on private plans but we haven’t really sat down and done the hard work necessary to consider market-based solutions. This is America, shouldn’t we give that a shot first before giving up and consigning most Americans to a government run plan that is rushed through Congress in a matter of weeks and months?
Representative I challenge you to do better! Reforming health care in America won’t be easy and it won’t be quick; however, I truly believe we can make fundamental changes that will improve access to coverage. One of the first challenges, perhaps the most important, will be tackling the issue of “uninsurables” by requiring insurers to accept all applicants regardless of pre-existing conditions. If we can solve that one problem, it will go a long way toward opening up private insurance to millions more Americans without the risk of a Government-run health care system.
Now, it will never guarantee coverage to everyone, but it will be a system we can be proud of and have faith in, knowing that it’s a uniquely American solution. And, yes, we will still have public programs – revamped and more efficient – to help those who truly need the most help.
I hope you will step back this summer and take a longer look at this issue. We can do so much better than what is proposed, if we just make the effort to go above and beyond business as usual in Washington.
Tags: campaign, constitution, Health, obama, president, socialism, taxes
If you are going to enact sweeping legislation to remake the face of health care in America while giving the federal government unheard and unconstitutional control, then common sense dictates a clear, orderly systematic manner of paying for any additional costs. None of the major plans laid out by Democrats have laid out a method of paying for costs that will work today, tomorrow, and in 50 years. Rather they offer a hodgepodge of taxing ideas, including Medicare savings that are highly speculative.
In late July Peggy Noonan offered some thoughts on President Obama’s health care missteps as well as some common sense realities that are helping drive American opposition to socialized medicine.