New York Times Editorial: A Strong Health Reform Bill

New York Times Editorial: A Strong Health Reform Bill
Copyright by The New York Times
Published: July 15, 2009
http://www.nytimes.com/2009/07/16/opinion/16thu1.html?th&emc=th


While the Senate continues to struggle over its approach to health care reform, House Democratic leaders have unveiled a bill that would go a long way toward solving the nation’s health insurance problems without driving up the deficit. It is already drawing fierce opposition from business groups and many Republicans. This is a bill worth fighting for.

The bill would require virtually all Americans to carry health insurance or pay a penalty. And it would require all but the smallest businesses to provide health insurance for their workers or pay a substantial fee. It would also expand Medicaid to cover many more poor people, and it would create new exchanges through which millions of middle-class Americans could buy health insurance with the help of government subsidies. The result would be near-universal coverage at a surprisingly manageable cost to the federal government.

The nonpartisan Congressional Budget Office estimates that by 2015, 97 percent of all residents, excluding illegal immigrants, would have health insurance. The price tag for this near-universal coverage was pegged by the budget office at just more than $1 trillion over 10 years — at the low-end of the estimates we’ve heard in recent weeks.

The legislation would pay for half that cost by reducing spending on Medicare, a staple of all reform plans. It would pay for the other half by raising $544 billion over the next decade with a graduated income surtax on the wealthiest Americans: families with adjusted gross incomes exceeding $350,000 and individuals making more than $280,000.

Predictably, the idea of raising taxes this way has critics outraged, with some charging that it is unfair to require a small sliver of the population to bear the brunt of the cost.

The wealthy have benefited greatly from Bush-era tax cuts, and their incomes have risen disproportionately in recent years. It seems proper that they should contribute heavily to an effort that is vital to hard-pressed Americans and to the long-term health of the economy.

The legislation also includes some sound ideas for slowing the inexorable rise in health care costs. Such savings are also essential for the nation’s economic health. It adjusts Medicare reimbursements to encourage health care providers to improve productivity, reduce costly hospital readmissions and spend more time on primary care that can head off the need for costly specialists. It expands prevention and wellness activities.

And it establishes a center to compare the effectiveness of various drugs, devices and procedures. Unfortunately, it prohibits the government from requiring public or private insurers to set reimbursement policies based on the findings. These steps may not produce big savings quickly but could lower costs in future years.

The bill makes a mockery of Republican claims that the Democrats are pushing a hugely costly government takeover of medicine.

This bill is clearly not hugely costly. It would expand the government’s role in financing and regulating coverage but would also bolster private coverage. It would increase employer-based coverage, mostly by requiring employers to participate. And it would send more clients to the private insurance industry. The Congressional Budget Office estimates that perhaps 10 million people might enroll in a new public plan, while twice that number might enroll in competing private policies.

The Senate health committee has approved, by a party-line vote, a bill that in many respects parallels the House bill. The Senate Finance Committee, hoping to win over Republicans and conservative Democrats, is balking at a public plan and raising taxes on the wealthy. If there is a deal to be had, it is worth discussing. But the House has set a clear standard for health care reform: It must cover all Americans without driving up the deficit.