of Costs and Care and the Uninsured and what the Future Brings.
Time to pivot away from outrage at the crazies and towards the reasons why health care reform is necessary and what reform will cost and look like. The teabaggers may or may not have intended from the beginning to create the biggest gawker slowdown in recent legislative history, but that has certainly been the effect. Either way, though, they’ve overplayed their hand and their purported grassroots anger toward health care reform morphed into deranged rants that cannot possibly be persuasive to a majority of Americans, as Kos demonstrated with polling data today.
But discrediting the opposition is and should be insufficient to make the case for health care reform. Health care is complicated and reform is a level of complication beyond that. How then to present the case in a way to make Harry and Louse envious? My suggestions follow.
(Please note, with a particular sensitivity to the sentiments of Angry Mouse, that this analysis is to the extent possible, non ideological: this is an analytical path and not an attempt to dictate outcomes).
There are two issues in the health care debate: (i) whether health care insurance reform is necessary and (ii) if reform is necessary, what form it should take.
Note Bene: the two issues in the debate are only about health care insurance and not about health care itself. For better or worse, the health care quality and supply we will have the day after a reform bill is passed, if it is passed, will be the same health care quality and supply we had the day before.
See http://www.physiciansnews.com/... which points out provisions that "promotes" and "encourages" various administrative practices, but does not change the quality or supply of care itself.
First, whether reform is necessary. 85% of all Americans are covered by health care insurance and 70% say they are satisfied with their coverage. If it’s not that broke why fix it? I have not studied those polls but I am guessing that the 70% were basing their satisfaction on the treatment offered by their health care providers, not necessarily the cost of that care. Their satisfaction would almost certainly evaporate if (i) the cost of their care would double over the next ten years (ii) their policy was canceled if they got sick, or lost or changed their jobs, or (iii) they could no longer afford the premiums or (iv) they were denied insurance altogether after their existing policy were cancelled.
The overriding reason for the need for healthcare insurance reform, though, is the skyrocketing cost to individuals, employers, business and the government.
So the reason why reform is necessary leads directly to the debate over the second issue: what form should reform take? I have developed an acronym and mnemonic which the debate on this issue could use:
PAC 2 Insurance.
Namely, any reform bill adopted into law would impose PAC 2 standards on all health insurance polices offered or sold anywhere in the United States by any entity, public or private. Those standards are:
(1st PAC)
Portable
Affordable
Choosable
(2nd PAC)
Permanent
Accessible
Cost-Capped
I readily admit that I am trying to fix an acronym around a policy, but I also am trying to make manageable a debate that has thousands of nooks and crannies and every question about what reform will look like should logically fit into the larger framework that health care insurance reform must take.
Herewith my explanation for each of the listed standards.
Portable
The policy cannot be cancelled merely because you change jobs. (I think employer-based health insurance is a Rube Goldberg contraption, but Rome cannot be rebuilt in a day).
Affordable
Any health insurance policy must be affordable according to the same formula that is used for "Affordable Housing" i.e. premiums cannot exceed a fixed percentage of any given community’s median wage.
Choosable
Consumers have the right to choose from a menu of different plans or from a "healthcare insurance exchange" (OK, maybe it’s not a word except for computer geeks, but it works in this context, so sue me).
Permanent
Your health insurance policy cannot be cancelled or changed no matter your age or condition of health for as long as you are alive.
Accessible
You are guaranteed the ability to buy an insurance policy at an affordable price so long as you live regardless of your age, health or previous condition of servitude. (a synonym for Universal, perhaps, but that ruins the anagram)
Cost capped
Your total cost of health care will not increase more than the inflation rate.This standard will be the toughest to meet, but if it requires a tax subsidy that is the debate we must have.
Because this analytical framework is a path to a solution, it does not dictate whether that solution must have a public option (Gasp!) The public option debate seems to driven more by ideology and less by reason even though I happen to think if you follow the logic path laid out above, a reasonable person will conclude that a public option must be created in the final reform bill because the cost-capped standard is not achievable without an insurer in the market place that is not profit driven (even though the public entity must at the end of the day balance its books).
In any event , the ideological fight is partly drained from this debate by the analytical framework proposed because the reform bill is agnostic about what kind of entities offers heath care insurance, public, or private, profit or nonprofit.
The health care insurance industry itself is thoroughly familiar with minimum standards imposed by state governments on the health care policies now sold to individuals and groups. See e.g. a provision on Minnesota state law, M.S.A.Sec 62E.01 to 62E.17, entitled Duties of Insurers, that dictates accessibility and coverage. ( The problem of course is that state law does not cover a national population and only the federal government can impose minimum standards on all health care insurance policies everywhere in the country.)
The final, most critical question, then, is how much such a reform bill will cost. I must defer to the OMB and CBO and accept their estimates of about $100 billion a year increase in the federal budget. Not so much when added to a $3.7 trillion budget, and certainly not "trillions in wild spending" that the Republicans claim. Obama thinks he can find about $50 billion in savings increased efficiencies and I would think that a repeal of the Bush tax cuts would cover the rest. But if the worst that would happen is a 2.7% increase in the federal budget, then I would look for a 2.7 % cut in the rest of the government.
I sort of see this website as a peer-reviewed citizen journalist publication, so start peer reviewing. Using the framework set forth above, I should be able to respond quickly, succinctly, accurately and persuasively in favor of Obama's reform proposals, as I understand them, to any response to this diary or to the larger health care reform debate, whether those responses are from the crazy or sane, curious or contemptuous, democrat or republican, drunk or sober. Bring it on.