Thursday, September 17, 2009

And the winner is ... not Senator Baucus.

I had such high hopes for the Senate Finance Committee's chances for constructing a comprehensive health care reform plan that I could support. Forget one that the Senate or Congress itself or even Republicans could support; I can't support this plan.

At least he was working on it, and with more than just members of his own party. I don't place much stock in bipartisanism, actually. Bipartisanism is just another way of keeping Congress and the president humble; it's not always the answer. However, in the case of Senator Baucus, for a time he was open to ideas that most of his colleagues in the Senate and House leaderships simply were not. Still, the bill he finally came up with, while better than the other bills produced by Congress and the president, is not enough.

I know; I'm a hard man to please. I want health care reform that targets waste and fraud for elimination; that has significant tort reform included; that requires neither businesses to provide coverage nor private citizens to purchase it, but rather incentivizes both; that includes neither a government-run plan nor health care co-ops, but increases free market opportunities and solutions; and that, in the words of our president, "doesn't add a dime to the deficit". That's a pretty tall order, I realize.

It gets worse. Instead of requiring people to purchase coverage, I want the government to incentivize purchase by making every dollar spent on health insurance tax deductible. As I've written before, the president's comparison between mandated health insurance and mandated auto insurance is a bad one. The Congressional Budget Office said as much the first time President Bill Clinton proposed a universal mandate in 1994:

"A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action," the CBO said.

Interestingly, the closest thing the CBO could find to mandatory health insurance was the draft.

"Federal mandates that apply to individuals as members of society are extremely rare. One example is the requirement that draft-age men register with the Selective Service System. The Congressional Budget Office (CBO) is not aware of any others imposed by current federal law," the report said.

Instead of requiring businesses to provide coverage and imposing fines on any business that doesn't, I want the government to offer tax breaks to any business, small or large, that does. This would have the added benefit, of course, of stimulating the economy when it needs it the most. The government has spent hundreds of billions of dollars in the last half-year alone trying to reverse the economic downturn in this country. All it's been able to do, though, is slow the decline. Unemployment has continued to rise to almost ten percent in this country. That's almost twenty million Americans. Could that number have some correlation to the number of uninsured in this country? If the government lowers taxes for any business that offers health coverage for its employees, then not only will more companies offer insurance, but more companies will be able to afford more new hires, and more small businesses will arise. It's the equivalent of two birds with one stone.

Instead of a government plan or co-ops, make it easier for insurance companies to become competitive with each other. The president spoke before Congress of states where some insurance companies had essentially cornered the markets. I say, let's make health care purchasable across state lines. Not only would the best companies be able to expand their markets and force the worst companies to adjust their practices, but it would make health insurance an actual interstate commerce issue, which would make reform and oversight much easier to provide. It would also shift the twin tasks of reform and oversight from the state to the federal level, if I'm not mistaken, relieving states of some of the burdens. I'm not usually one for expanding government power or regulation, but sometimes it can actually be the answer.

Which brings us around to not telling insurance companies how to conduct business. Almost every American has or knows someone who has a "preexisting condition". Refusing to provide insurance in those cases makes very little sense; that is, unless you look at it from a business perspective. After all, it's much cheaper to to cover a healthy person than a sick one. I don't think those with preexisting conditions should be denied coverage; but if an insurance company is going to provide it, then the company should be allowed to set the rates. All lending and coverage is based on risk assessment, whether it's a bank loan or an automobile insurance policy; health insurance policies should work the same way.

The president's claim that he wants a bill that doesn't increase the deficit either now or later is a bold one; in the eyes of some, it's an impossible one. I'm just a lowly blogger. What do I know of the budget process, or what kind of spending or tax cuts or increases would be required to make this or any other reform plan deficit-neutral? Nothing, that's what I know. But there are those who do, and to them I say, "This is what I want to see in health care reform; and as my elected representative, I expect you to either work for these reforms or explain to me why your ideas are better." You should all call, visit, and/or write to your representatives, including the president, and say the same.

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