Now that President Obama has outlined his goals for an overhaul of the American health care system, Democrats are trying to fashion new legislation that will include all of Obama’s aims. The president wants a new government-run insurance program, additional regulations for the insurance industry and rules requiring all Americans to buy insurance if they can afford it or be given coverage if they can’t. Obama’s plan draws elements from the multiple bills in Congress. But in trying to merge the ideas into a compromise bill, Democratic leaders face a series of inconvenient questions:
1. Who would foot the bill for extending health insurance to 30 million more Americans?
Obama’s plan draws heavily from a proposal in the Senate Finance Committee that would tax insurance companies that provide expensive health plans. There would be new taxes on drugs and health care providers. The House would impose a tax on incomes of more than $280,000 for individuals and $350,000 for couples. No proposed plan would cover all the costs.
2. Would doctors and hospitals be able to cope with the expected influx of millions of new patients?
Advocates say that many new enrollees would be young and not in need of frequent medical care and that preventive care would help stave off diseases that require more services. But many of the newly insured would also be poor and suffering from chronic conditions. Critics expect long waits for medical services as in Europe and Canada.
3. Wouldn’t illegal immigrants still get care, often for free, in hospitals?
No bill would block free hospital care for illegal immigrants. The House bill would not allow illegal immigrants to receive subsidized care, but there is nothing in the bill that would prohibit illegals from buying insurance policies or joining the government option. The Senate bill will likely block subsidized coverage for illegals.
4. Who would enforce the requirement that individuals have coverage?
The IRS would be the chief enforcer of the individual mandate. That’s because the government would impose an additional income tax on those who do not purchase coverage. The IRS would verify coverage claims with the names and Social Security numbers of customers provided to the agency by insurers. The IRS would also evaluate individual incomes to determine eligibility for subsidized coverage.
5. Will employers stop providing health care coverage if a public plan is available?
There is no plan in Congress to prevent this. The Congressional Budget Office found that if one Democratic plan in the Senate becomes law, “about 6 million people who would have employment-based coverage under current law would not have such coverage under the proposal.”
6. How can spending less on Medicare produce better care for participants?
The president says that cutting $500 billion from Medicare in the next decade will rid the system of waste and fraud and increase access to care. But members of both parties are worried about the president’s plan to give an appointed board power to make the cuts, as well as access to care in rural areas.
7. What other programs would need to be cut if Obama’s promised savings don’t materialize?
The president said in his address to Congress that if the hundreds of billions of dollars in government health savings don’t materialize, he would find savings in other areas. But only 38 percent of the federal budget is subject to cuts, and that includes hard-to-trim departments like Defense, Transportation and Education.
8. Similar plans have failed in several states. How would a federal plan avoid the same fate?
Critics of the Democratic plans say the outcome would be similar to public plans initiated in several states that have either failed completely, like Hawaii, or are struggling, like Massachusetts, where the program has been deemed too costly for residents and too expensive for the state to afford. Advocates say savings and efficiencies are possible if all 310 million Americans are subject to the plan.
9. Can the president make good on his promise not to “add one dime” to the national debt?
The Congressional Budget Office estimates the House health care bill will increase the deficit by $239 billion over the next 10 years, while the Senate bill would add more than $1 trillion to the national debt in the next decade. Democrats discount those figures, saying they do not include the savings they anticipate.
10. The president says that he can save $500 billion in waste and fraud in Medicare. Has the government ever succeeded in such an ambitious cutting effort?
The government has never been able to save money on this scale. Most recently, Obama’s effort to make cuts at the Cabinet level yielded about $267 million in savings. And the government’s biggest effort yet, initiated by then-Vice President Al Gore in 1993, claimed savings of just $12.3 billion after four years.
11. Is it true, as the president and Democratic leaders have argued, that “special interests” are trying to block reform?
The pharmaceutical industry has already cut a deal with the administration to lower drug costs for seniors and will be paying for $150 million in pro-reform advertising. The American Medical Association last week approved the Obama plan. AARP, one of the nation’s largest insurers, has spent millions of dollars on pro-reform ads.
12. Do we need “demonstration projects” on medical malpractice reforms to find effective ways to control lawsuit costs?
In Texas, 2005 limits on damages in malpractice cases has led to a 27 percent decrease in malpractice premiums. An additional half-dozen states have cut frivolous suits through similar means. Obama’s decision to do yet more state testing, rather than propose legislative changes, leaves critics worrying that he has no intention of implementing nationwide reform.
