When Jim Villanucci was kind enough to invite me on to KKOB for a few hours last week, I was expecting the usual tea party accusations that health-care reform is a government takeover of 1/6 of the economy.
What I wasn’t expecting was to hear such a high percentage of callers admit that they, or someone in their family, receives some kind of taxpayer-subsidized health care.
They uniformly said current government health programs were working just fine. Strangely, though, many callers claim that the newly passed reform is a socialist government takeover.
Beyond the hypocrisy of enjoying government health care while trying to deny it to others, the tea partiers have missed the biggest story about reform: It is the furthest thing imaginable from a government takeover of health care.
All health-care reform does is take the current private system and ensure access to care for sick people. That’s it. That one basic principle of guaranteed issue requires three follow-ups: community rating, full participation and some subsidies, but those are simply necessary components to enforce the idea that pre-existing conditions shouldn’t stop you from getting care, whether you currently have insurance or not.
Carter Bundy
How else?
Seems pretty common sense that a health-care system should cover sick people. In order for sick people to get care, the first thing you have to have is “guaranteed issue.” That just means that insurance companies have to offer coverage to everyone, and they can’t kick you off if you get sick or if your illness is an expensive one.
But, of course, that means nothing if the insurance company smiles at you and says “sure, we’ll cover you. For $5,000 a month.” There have to be caps on what the premiums are, or there’s not even a chance of covering pre-existing conditions.
Caps are called “community rating,” and the new reform has a weak version of community rating. The new law doesn’t require everyone to pay the same thing – insurance companies can charge healthier people as little as 1/3 of what sick people pay. But at least there is some community rating.
Guaranteed issue and some community rating are necessary elements to covering people when they get sick, but they’re not sufficient. If you know you can buy insurance even after you get sick, don’t you have a strong incentive to not pay anything until then? Yes.
That’s where the “individual mandate” comes in. If you did everything else right, but didn’t require everyone to participate, existing insurance pools would suffer from “adverse selection” – only the sick would be in the pools.
After all, why would you ever pay a dime into the system if you knew you could get coverage if you became sick? The real term that ought to be used is “full participation,” because that’s all it is. Without full participation, the system collapses.
What I’d love to hear from opponents of full participation is how else the system can take people with pre-existing conditions without collapsing from adverse selection. How do they avoid people dropping out and free-riding until they’re sick?
Finally, if you’re going to require full participation, you also have to make sure that no one’s budget gets busted in the process – whether individuals or small business – so there have to be subsidies for lower-income people. Businesses with fewer than 50 employees aren’t required to buy insurance at all, but if they want to (and many do) they’ll get help as well.
Who pays for those subsidies? The short version is that unless you’re a millionaire or run a private company that scams profits off of taxpayers and seniors in Medicare Advantage, it’s not you.
What’s so scary?
That really is the bulk of health care reform. Insurance companies have to offer coverage within a range of prices, they can’t cut you off, everyone has to participate, and there will be subsidies for those who can’t afford it and for small businesses.
We’re using the same system we’ve had for a century, we’re using the same private providers, and we’re using the same private insurance companies. The only difference is now insurance companies can’t exclude or kick people out for being sick. That’s socialist in what way?
If anything, the 2010 version of health care reform is timid. After all, it’s nothing more than the 1994 Republican alternative to the Clintons’ proposals, and even as recently as 2006 Republican superstar Mitt Romney was defending Massachusetts’ individual mandate – the one he signed into law as the Republican governor of Massachusetts.
So let’s not pretend that the health-care reform that just passed is some socialist plot, or government takeover, or the end of freedom as we know it. Only two types of people make those claims: those ignorant of what’s in the bill, and those who know better but who are hoping for political gain based on fear.
Conservatives will talk of “repeal and replace,” but not a single conservative alternative passes the first principle of any health reform: ensuring coverage if you get sick.
While there is some merit in some of the conservative ideas that didn’t make it into this year’s reform, particularly on some cost issues, their plans ultimately boil down to “don’t get sick.” That’s not reform, and it’s certainly not health care. All they’re left with is pretending that health care reform is scary, when the truth is it’s anything but.
Bundy is the political and legislative director for AFSCME in New Mexico. The opinions in his column are personal and do not necessarily reflect any official AFSCME position. You can learn more about him by clicking here. Contact him at carterbundy@yahoo.com.