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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

New Health Reform Strategy Takes Shape

Bob Rosenblatt’s L.A. Times article “A National Healthcare Reform Primer” is a good place to start getting up to speed on the major issues of the current debate on health care refom strategy. In the Q&A section of his article, Rosenblatt does a good job of explaining how health care reform would be financed:

How can the country pay for a reworking of its health insurance system?
Obama has proposed a down payment of $630 billion. Most of the money would come from an increase in federal income taxes by limiting deductions for people making more than $250,000 a year…He also wants to cut payments to Medicare HMOs, saving about $175 billion over 10 years, according to the budget plan issued Thursday. This program, known as Medicare Advantage, requires enrollees to get their hospital and doctor care within a network of providers. In return, they get extra benefits, such as dental care, which are not included in the regular Medicare program. Under regular Medicare, called fee-for-service, the beneficiary can see any doctor or hospital where Medicare payments are accepted.

Rosenblatt also discusses other funding mechanisms under consideration, including: capping the federal income tax deduction for health insurance; creating a special tax dedicated for healthcare; and finding ways to make the system more efficient.
For an interesting look at the key health care strategy players, read “On Health, President Takes Team Approach” by Robert Pear and Jeff Zeleny of The New York Times. The authors focus on the following members of Obama’s health care reform team: Gov. Kathleen Sebelius, the President’s nominee for Secretary of HHS; Nancy-Ann DeParle, counselor to the president and director of the White House Office for Health Reform, is not subject to Senate confirmation; Peter R. Orszag, director of the White House Office of Management and Budget, “a dominant voice on health policy within the administration” ; Dr. Ezekiel J. Emanuel, brother of Rahm Emanuel, an oncologist and medical ethicist and “kibitzer-in-chief on health policy”; Melody C. Barnes, director of the Domestic Policy Council at the White House, and Lawrence H. Summers, the director of the National Economic Council
In her Wall St. Journal article, “Tough Questions Dog Health-Care Overhaul,” Laura Meckler focuses on Obama’s proposed “system in which people could buy insurance through a government-organized marketplace, where private plans and a new government-run plan would compete.” and notes:

If the government were to require businesses to offer insurance, it would have to set a standard for what counts as insurance. Would a bare-bones plan with limited coverage qualify? Businesses and others would likely wince at the idea of government setting standards for the benefits they must offer….During his campaign, Mr. Obama proposed that large businesses be required to offer coverage or pay into a fund, while small businesses that offer coverage would get a tax credit…Many Democrats insist that there be a public option. Some say it would provide a test for whether Americans prefer a government-run system similar to what exists in Canada. But opponents say it would skew the playing field because government will always be able to undercut private insurers’ prices.

What I crave most as a health insurance consumer is simplicity. I don’t want to be what the insurance companies call “an educated consumer,” who has to spend a lot of time reading their brochures and making cafeteria-style decisions about my “benefit options” based on their constantly changing coverage and too often dishonored promises. I want everything covered — a little card that guarantees that any illness or health issue that befalls me or my family will not entail ruinous medical expenses, and requires nothing more than a modest co-payment from me for anything. It doesn’t seem like a lot to ask for in the most prosperous nation in world history.
Right now, I have to believe goverment is likely to be the more credible provider of such a promise, since private insurers have only cut benefits and raised prices in recent years. Theoretically, at least, it should be possible for insurance companies to compete on the basis of who can provide the most affordable insurance that truly covers every illness, without the expensive “optional” add-ons like “cancer insurance” private providers offer today. If one of the big companies had the guts to offer such a truly comprehensive package, I suspect they would bury the competition.
Health security for millions of Americans has always been discussed as something separate from “national security,” and I sometimes wonder if that’s a key reason why comprehensive health insurance that covers everyone and every illness has been such a tough sell. When it comes to saving the lives of Americans, the failures of our health care delivery system have probably done more real damage to our citizens than all of the terrorists threatening America put together. Yet it’s politically easier to dump $5 billion a week into the Iraq quagmire than it is to spend about the same amount– $250 billion a year — to provide coverage for all of the uninsured (American Enterprise Institute maximum estimate, quoted in Rosenblatt’s article).
The same is true to some extent for the relationship of health care reform to the success of the economic reform package. As Governor Jennifer Granholm noted on MSNBC’s “Hardball” on Sunday, Ontario produced more cars than Michigan last year — for the first time ever. Conservatives can’t blame it on their traditional boogeymen, taxes and regulation, since Canada has more of both. As Granholm explained about the auto companies, “They were going there because of health care.” Ontario’s edge for auto companies is due to Canada’s more efficient health care system, which makes cars produced there less expensive than in the U.S., where health insurance adds $1200-1500 to the price of every car, according to Granholm. Regardless of the specific policies at issue, clearly health care reform should be pitched more assetively as a critical component of both economic and national security.

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