health & medicalpolitics & government

Getting radical with health care reform

Confronted with a dilemma that begs for remedying, the instructive aphorism goes: get to the root of the problem. This cliche adage of deracination implies that the most efficient way to correct any issue is not to pluck minor branches or leaves, but to uproot the plant all together — to not treat the ailments, but the sickness itself.

There is a word that categorizes this philosophical bent toward problem-solving. It’s called radicalism, and the word’s connotations have undergone a transformation during it’s timeline of etymology. When spoken, it is often thought of as a brazen and irreverent worldview that aims to pick-apart orthodoxy whenever possible — just because it can.

This is both unfair and unfortunate. Consult the online version of the current Miriam-Webster dictionary, and you will find this first definition of the word radical:

rad·i·cal (1) of, relating to, or proceeding from a root.

It is coincidental that President Obama has described some of Sen. Ron Wyden’s (D-OR) ideas for health care reform as such. The President has long espoused a need for altering the most inefficient health care system among industrialized nations.

A summary of major Wyden revisions:

Under Wyden’s plan, employers would no longer provide health coverage, as they have since World War II. Instead, they’d convert the current cost of coverage into additional salary for employees. Individuals would use this money to buy insurance, which they would be required to have. Private insurance plans would compete on features and price but would have to offer benefits at least equivalent to the Blue Cross “standard” option. Signing up for insurance would be as easy as ticking off a box on your tax return. In most cases, insurance premiums would be withheld from paychecks, as they are now.

But Obama and congressional Democrats’ are falling short of true reformist headway, and are merely plucking the leaves and branches of a much larger problem.

The thorniest attribute of leading bills, and a major contention among Republicans and moderate Democrats, is cost, especially with the leading bill in the House.

The Congressional Budget Office says the government would spend $773 billion on subsidies from 2013 to 2019 under the House bill. Among people who receive assistance, it said, the average subsidy would be $4,600 in 2014, rising to $6,000 a person in 2019. [emphasis mine]

However, as political to-and-froing continues over the cost of any legislation, the amount of money given in subsidies to Americans in all economic brackets will likely diminish in order to alleviate the concerns of Congress over the cost. Obviously, diminished subsidies equals diminished aid to Americans who have little practical recourse to either private or employer-based insurance.

Jacob Weisberg recently wrote in Slate an interesting piece that tackles our health care system from a broader standpoint: from a moral, financial, and sociological perspective. He finds an especially tenuous disconnect with the latter:

It is on the sociological level, though, that we’re missing the boat most completely by sticking doggedly with a workplace-based system that no longer makes sense. America has always been a mobile society with a labor market that grows more fluid over time. Once, the norm was to work for a single employer for one’s entire career. Today, people change jobs an average of 11 times before they reach 40. Fear of losing health coverage keeps people in jobs they would otherwise leave, creating a drag on economic efficiency. As the Senate’s smartest health care wonk, Ron Wyden of Oregon, says: “A big part of the reform challenge is to look at how the culture of the American workforce has changed since the basic structure of American health care was put in place. Today’s culture is all about flexibility.”

Wyden’s plan acknowledges this:

Eliminating employers as an additional payer would encourage consumers to use health care more efficiently. Getting rid of the employer tax deduction, which costs a whopping $200 billion a year, would free up funds to subsidize insurance up to 400 percent of the poverty line, which is $82,000 for a family of four. The Lewin Group, an independent consulting firm, has estimated that Wyden’s plan would reduce overall national spending on health care by $1.5 trillion over the next 10 years and that it would save the government money through great administrative efficiency and competition. [emphasis mine]

Wyden’s plan, co-developed by Senator Bob Bennett (R-UT), adapts health care to the realities of American life. No longer will there be a basis on an antiquated employer-based system to counter private insurance providers. Employers will be unburdened with expensive health care fees, people will have increased (and better) options with competing private and government-funded insurance programs, and it satiates those concerned with increasing the national debt.

David Brooks astutely summarized the current conditions of health care reform back in June:

In the World’s Greatest Deliberative Body, senators don’t run things. Chairmen and their staffs run things. During the spring, as the Obama administration faded to invisibility, the finance and health committees separately put together plans. These plans did not alter the employer exemption. They did build on the current system. They did include approaches that have been around since Richard Nixon.

The problem with the committee plans is that they don’t do much to change the underlying incentives, and consequently don’t do much to control costs. “The single most expensive option is to build on the existing system,” says the health care costs guru John Sheils of the Lewin Group.

And with regards as to why the Wyden-Bennett plan has not gained the necessary traction in committees to propel the plan into the wider consciousness within Congress and among the general public, well, rest assured; politics still runs Washington:

The left is uncomfortable with the language of choice and competition. Unions want to protect the benefits packages in their contracts. Campaign consultants are horrified at the thought of fiddling with a popular special privilege.

It’s a shame to think that political wringing is going to stifle a reform plan that unburdens employers from expensive health care management, gives employees greater freedom toward job attainment over their entire lives, and would be revenue-neutral, foregoing the piling-on of additional billions of dollars on the already bloated national debt. Wyden’s plan is perfect for political ecumenicism: Democrats get their universal coverage, and Republicans get to keep their principles of choice and competition.

Obama is perfectly right in calling Wyden a radical of health care reform. “There need to be some tough choices made now,” Wyden said last week. “Everybody has been trying to stay in their comfort zones, and we need to get out of that.”

It’s time to get radical.

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One Response to “Getting radical with health care reform”

  1. Very interesting column. Is it because I have been away in the mountains for two weeks that this is the first I have heard of this, or it it because the media is doing its usual sterling job of telling us only what they want us to hear?

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