The best healthcare reform bill introduced in congress during the recent healthcare overhaul debate, The Healthy Americans Act, came from Senators Ron Wyden (D, OR) and Bob Bennett (R, UT) and was supported by a number of lawmakers from both sides of the aisle. Unfortunately, due to a number of sacred cows the bill would have tipped, it was never seriously considered by Senate leadership or the president.
Now Ron Wyden is back, this time with Senator Scott Brown (R, MA) hoping to pass a new bill aimed at putting healthcare reform back in the hands of the states. Any state government that wants to implement their own reforms rather than rely on the Federal government’s healthcare bill would be able to – provided they met or exceeded the standards set by the federal bill. Here’s Ezra Klein with some background:
Wyden, with the help of Sen. Bernie Sanders (I-Vt.), was able to build a version of this exemption into the original health-care reform bill, but for various reasons, was forced to accept a starting date of 2017 — three years after the Patient Protection and Affordable Care Act goes into effect. The Wyden/Brown legislation would allow states to propose their alternatives now and start implementing them in 2014, rather than wasting time and money setting up a federal structure that they don’t plan to use.
Reihan Salam is worried that the language in the bill will make conservative healthcare reform proposals impossible to implement, limiting reform to blue states and centralized solutions:
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My understanding is that a consumer-directed system by suggests something like catastrophic coverage, modified by first-dollar coverage for preventive services, let’s say. Would that fall under the “as comprehensive” rubric? I’m guessing that the answer is no.
And so Vermont is allowed to go for a more comprehensive and centralized approach, while Utah and Indiana and Texas will not be allowed to embrace an HSA-driven catastrophic approach. I could be wrong, but I fear that the deck is stacked. Given that Sen. Scott Brown represents Massachusetts, it’s not surprising that he’d embrace this idea. But again, I think conservatives should ask for more. Let’s not dismiss this proposal out of hand, but let’s see if Sens. Wyden and Brown are open to a more level playing-field.
This is a reasonable concern. I think overall this is a very good idea, but I agree with Reihan that conservatives should push for more room to experiment with market-based or consumer-driven approaches. I think we could have a much more serious conversation about healthcare reform if we were able to truly see different examples in action across the country.
I have some concerns, however, about the nature of state-based healthcare reform. At the root of rising healthcare costs and poor access to healthcare are a number of national issues that can’t be easily solved on a state-by-state basis. For instance, insurance companies are prohibited from selling insurance across state lines. It becomes very difficult to create the sort of risk pools necessary to cheaply insure Americans when those pools are confined to states. So as much as I like the idea of state-based solutions and little ‘laboratories of democracy’ in action, some of the systemic issues in healthcare reform stem from regulations at the federal level.
Likewise, the tax exemption for employee benefits is a federal issue as well and will need to be resolved eventually if we’re ever going to be able to move to a better way of acquiring insurance. Cartelization of the medical industry is similarly national in scope and also contributes to out-of-control health costs.
So as fond as I truly am of the new Wyden/Brown legislation (with the caveats that Reihan mentions) I’m afraid that it won’t strike at some of the more fundamentally screwed up parts of our healthcare system. This doesn’t mean it’s not a good step to take, but it only gets us a little closer to the long-term goal of a sustainable, fair, and still innovative healthcare industry in the United States.
