This week we learned the Republican version of national health care reform will increase the number of uninsured in this country by 14 million people in 2018. This estimate comes from the nonpartisan Congressional Budget Office (CBO) and will be cited by many as reason to kill the bill.
What will get less attention are estimates in the same CBO study that the Republican plan will reduce the federal deficit by $337 billion over the next 10 years, and, after a two-year transition period, cause insurance premiums to decrease.
So, like the Patient Protection and Affordable Care Act (also known as Obamacare), there are good things and bad things in the new health reform legislation. The trick is to find the proper balance between expanding insurance coverage and containing health care costs.
Gov. Mike Leavitt and Donna Shalala are both health care experts and remarkable public servants. Both served as secretary of Health and Human Services. Shalala served in a Democratic administration under President Bill Clinton. Leavitt served in a Republican administration under President George W. Bush.
Several years ago, shortly after the passage of Obamacare, Leavitt and Shalala spoke on a panel about health care reform in the United States. Instead of the usual finger-pointing, talking past each other, or debating about over-simplified talking points, they looked each other in the eyes and acknowledged they had the same goal. They wanted everyone in the country to have access to high quality care at affordable prices. What made them different is how they attempt to achieve these goals.
This is where the conversation between conservatives and liberals gets interesting. Shalala expressed her desire to provide everyone insurance coverage. Once people have health insurance, she reasoned, people will receive preventative care and costs will fall.
Leavitt viewed things differently. He expressed his desire to contain costs. Once costs are contained, he reasoned, people will be able to afford health insurance.
Not surprisingly, Obamacare matches Shalala’s policy preference. Among other things, Obamacare bans insurers from denying coverage because of pre-existing conditions, mandates that all U.S. residents have health insurance, expands Medicaid, and provides extensive subsidies for people to buy health insurance. Predictably, the percentage of U.S. residents under 65 without health insurance plummeted from about 17 percent to 10 percent (U.S. Census Bureau). This is the public policy success of Obamacare.
Unfortunately, Obamacare does little to address the cost problem. Some have described Obamacare as adding passengers on the Titanic. The behemoth U.S. health care system is sinking, and we keep putting more people on board.
The Republican majority has now proposed its version of reform, which focuses on containing costs by expanding choice and competition. Unfortunately, it leaves many people without health insurance, in part, because it doesn’t mandate it, but also because it provides less funding for coverage.
I will leave it to readers to decide what they think about “repeal and replace,” but it’s not lost on me that cost and coverage are important. There is something to learn from both Leavitt and Shalala.
Rather than shouting at each other and retreating into our corners where the majority party passes major social policy without a single crossover vote, I’d suggest Republicans and Democrats consider the following:
First, acknowledge that health care in this country is so large, complicated and important that smart reform will benefit from the best ideas from both sides of the aisle. Let’s listen more, respect differences, and find common ground. We need to work together on this.
Second, redesign health care to focus on value, not volume, and benefit from competition and choice. We must change the system, not just add more people to the system.
And finally, strengthen and optimize the health care safety net. We fail if we ignore society’s most vulnerable populations.
There is a common ground to be found in health care reform if we make both cost and coverage priorities. The Republicans and Democrats both have something to offer.