Is Obama Backing Away from Universal Health Coverage?

Morgen on February 9, 2010 at 9:55 pm

Count me among those who believe the President will do everything within his power, including supporting the use of budget reconciliation, to push the existing health reform legislation to the finish line in Congress. Making only whatever alterations are necessary in order to forge a compromise between the House and Senate, and to garner the 51 votes needed in the Senate to pass a reconciliation bill. Once passed, this legislation is expected to add an additional 15 million people to the rolls of Medicaid, and to provide highly subsidized coverage for an additional 20 million people in a new government-run insurance exchange. While this would not quite achieve universal coverage, the plan is expected to result in coverage for 94% of Americans by 2019 (excluding illegal immigrants).

Which makes these comments from President Obama at Tuesday’s impromptu press conference quite interesting, if you are willing to take him at his word (emphasis added below):

Question: After meeting with you, John Boehner came out and told us, “The House can’t pass the health care bill it once passed; the Senate can’t pass the health care bill it once passed. Why would we have a conversation about legislation that can’t pass?” As a part of that, he said you and your White House and congressional Democrats should start over entirely from scratch on health care reform. How do you respond? Are you willing to do that?

THE PRESIDENT: Well, here’s how I responded to John in the meeting, and I’ve said this publicly before. There are some core goals that have to be met. We’ve got to control costs, both for families and businesses, but also for our government. Everybody out there who talks about deficits has to acknowledge that the single biggest driver of our deficits is health care spending. We cannot deal with our deficits and debt long term unless we get a handle on that. So that has to be part of a package.

Number two, we’ve got to deal with insurance abuses that affect millions of Americans who’ve got health insurance. And number three, we’ve got to make health insurance more available to folks in the individual market, as I just mentioned, in California, who are suddenly seeing their premiums go up 39 percent. That applies to the majority of small businesses, as well as sole proprietors. They are struggling.

That’s it: control costs, implement some new insurance industry regulations, and “make health insurance more available to folks in the individual market”. The latter of which seems to fall well short of the President’s original goal of universal coverage, and which could be accomplished a number of ways other than having the federal government pick up the bulk of the cost for the uninsured. For example by allowing insurers to market their products across state lines, or even by facilitating the creation of market-driven insurance exchanges, rather than the command and control structure contained within the Democrat bills.

Of course without significantly reigning in costs it’s highly unlikely that these types of efforts would result in anything approaching universal coverage. But this is the point Republicans in Congress have been trying to make: any financially viable reform has to begin with cost containment. It is just not plausible for a plan where the federal government provides subsidized coverage for 35+ million people to also reduce the growth rate in health spending at the same time.

Deal with costs first, then begin to address universal coverage down the road. Ideally through a re-structuring of tax subsidies, but perhaps also with some limited expansion of Medicaid coverage for very low-wage earners.

If the President is actually sincere about these being his primary goals, then there may actually be an opening for a bi-partisan solution on health reform. Particularly if he is really serious about addressing cost containment (think tort reform).

But of course the chances of this are virtually nil, and I suspect if called on this the President would claim that he is not backing away from universal coverage. If for no other reason that he would have a rebellion within the ranks of his own party if he did. But it will be interesting to see if any lefty bloggers pick up on the President’s choice of words today and begin to panic over this.

Category: Health & Education, Politics |