Editorial: Where's centrist health bill with common sense, compassion?
So what to make of the House health care legislation the Wall Street Journal's opinion page calls "the worst bill ever" and the New York Times praises as "a long stride toward universal coverage while remaining fiscally responsible"?
Suffice it to say, there is an almost impossible amount of ground to cover between those two poles as the House takes up Speaker Nancy Pelosi's H.R. 3962. A vote has been promised in short order.
Our position all along has been that the health care status quo in America isn't really working for anybody. Most importantly not for the tens of millions of uninsured Americans who committed the unpardonable sin - in some eyes - of getting sick, not for those of us left paying their bills because of cost-shifting, not for businesses trying to remain globally competitive, not for doctors who'd like to be free to do what's best for their patients without undue interference from a distant, dispassionate, sometimes overruling third party.
The U.S. has the most expensive health care in the world but not the best outcomes, despite false claims to the contrary. Overwhelming health costs are the dominant cause of personal bankruptcy. Neither is forgivable. No American may have a constitutional right to health care but many literally cannot live without it, which is about as fundamental as it gets. From where we sit, basic morality in a country as rich as this one requires finding a way to get them the care that is a desperate need, not a frivolous want. To deny them because of the blinders created by the often happy accident of one's own good health and that of one's family borders on cruel.
As such, doing nothing has never been an option.
That said, health care reform is the most difficult issue in one of the most challenging eras in memory. And what's specifically before us now is a House bill too one-sided in its creation and too flawed for passage.
First, we object on principle alone to dropping a nearly 2,000-page bill in the laps of legislators and expecting them to vote on it as early as a week later. Few if any will have personally read H.R. 3962 from cover to conclusion.
Second is the cost, an estimated $1.2 trillion over 10 years. President Obama has said he won't sign a bill that worsens already record-shattering deficits, but we just don't believe that. If past is prologue, as it almost always is, Congress simply does not own the discipline to reduce spending in other areas, or the will to end the wars in Iraq and Afghanistan, that is necessary to reduce the red ink.
Third, we are not as fearful of the "public option" as some folks are, given that Medicare, Medicaid and veterans health benefits are all public options that few would surrender. That said, the concerns of private insurers that they will be put at a disadvantage against any government plan that will artificially cap its costs at below-market reimbursement rates, that they will be subsidizing a competitor with their tax dollars, that businesses now providing private health insurance for their employees will drop it in favor of the cheaper public option, are not unreasonable.
Rather than regulate insurance companies through government-run "exchanges," removing the barriers to interstate competition between them - a change championed by Republicans - would be one way to naturally control costs without so much government meddling. Meanwhile, the public option should be restricted to those whom the private sector has clearly failed - those with pre-existing conditions, the suddenly jobless and their children. There should be a bigger role for federally subsidized community health clinics, as well.
The question, of course, becomes how you pay for that, which brings us to our fourth point. The Pelosi bill would attempt to make health insurance mandatory for all, even those young people who fancy themselves immortal and choose to roll the dice on their continued vigor. On the one hand, America is the land of the free, and coercing someone to purchase something he doesn't want runs counter to that. On the other, it's galling when that uninsured 27-year-old crashes his car, gets deposited in a crumpled heap in an emergency room and expects somebody else to pick up his tab. It's unfair to the rest of us. Pragmatically, the math doesn't work without that demographic because you need a pool of people who help pay for the services without much consuming them.
In any event, we take it as a given that taxes will have to go up for somebody to cover any health care plan - Democrats prefer the rich, of course, with a surtax mistakenly not indexed to inflation - and that the savings from elsewhere (including a Medicare with substantial unfunded liabilities) will not magically materialize. No, the timing couldn't be much worse in this recession, and yes, hiking taxes could arguably depress investment/job creation when America most needs it. But just as arguably, out-of-control health care costs are strangling small businesses and entrepreneurship now. Pick your poison.
Our position is that no one should get something for nothing. That would include beneficiaries of any public option, some of whom could afford reasonable premiums and deductibles if some entity would sell them a policy.
Fifth, we'd wager that Democrats would gain some very influential supporters if they would put their minds at ease with a clear assurance that federal funds under this plan will not pay for abortions. That is a battle best left to another day.
Sixth, the practice of defensive medicine drives up the cost of health care dramatically, yet there's no tort reform here as Dems plant a sloppy kiss on a favored constituency. Finally, members of Congress should have it no better than the people they represent. Any successful health care bill should apply to them, as well.
That is not to suggest this bill is a complete dud, as it does some things we like - providing incentives to produce more primary care physicians, allowing Uncle Sam to negotiate drug prices for Medicare beneficiaries - but as of now, the Pelosi bill is not ready for prime time. Indeed, if all Congress and Democrats in particular do is take this opportunity - the debate here has gone farther than ever - and create a massive new bureaucracy without containing costs or improving care or expanding choices, then what's the point?
We have never pretended to be experts on this subject. But we do strongly feel that the best bill hasn't been introduced yet, and that it should be a hyphenated one. Between the free-market-can-do-no-wrong conservatives and the-government-can-do-everything-for-everybody liberals there must be centrist, common-sense statesmen on Capitol Hill who can craft a truly bipartisan bill that compassionately recognizes the reality of our health care crisis while pragmatically acknowledging the nation's fiscal limitations.
Maybe that's wishful thinking, but that's our hope, and this bill isn't it.
Peoria Journal Star