Thursday, August 13, 2009

Interview with Senator Burr on WRAL

Here is an interesting interview with our (if you live in N.C.) senior Senator, Richard Burr (R-NC) where he discusses reform issues at length. The full interview is about 20 minutes long, but the first 5 minutes include a fairly detailed, and clear statement by him of his views on reform.

At 3:45-4:50 of the interview he talks about 3 things that are necessary for any bill that would garner his support.

(1) cover everyone. This is about as clear a call as I have heard anyone make for universal coverage in awhile, other than single payer advocates. He states that without covering everyone, you will never get rid of cost shifting, and it will harm his goal 2.

(2) create incentives for prevention, wellness, and chronic disease management, which he notes as the only hope of controlling costs.

(3)financial sustainability. He then states the unsustainability of the current system we have.

A few points. The bill Senator Burr co-sponsors, The Patients' Choice Act, doesn't meet all these criteria [Note, this is introduced into the House by Rep. Ryan (R-WI), but is the same bill that Sens. Coburn and Burr have co-sponsored in the Senate; this version is much easier to work with and navigate if you want to read the entire thing]. It won't cover everyone. But, neither will any of the other bills being seriously considered at this point, according to the scoring by CBO. A private score of the Patients' Choice Act says it will cover about 34 Million folks, but keep in mind that HSI's private scoring is showing more insurance coverage for all the bills than is CBO as I have written about earlier. I still can't find where CBO has scored the Patients' Choice Act....if anyone has evidence that they have, please send it to me, maybe I just missed it. At another point in the interview Sen. Burr talks about covering as many persons as possible. I don't mean to picky about this, I was just surprised how clearly he stated universal coverage as a criteria for his support. It will be impossible to get to universal coverage without some sort of public option in which people are automatically enrolled if they do nothing else.

Second, Senator Burr seems very clear in this interview that he considers that current track of the health care system to be unsustainable, so that doing nothing is not a good option.

Third, he seems open to dialogue and discussion of a compromise bill in the fall, though he says that he has been shut out, and actually says the Republicans have been shut out, but presumably the 3 Republicans on the Senate finance committee have been deeply engaged in negotiations. I see several places of obvious compromise between this bill and the various Democratic bills in Congress. First and foremost seems to be an agreement to ban pre-existing conditions. Folks seem to gloss over this, but it is really a big deal (and a bit puzzling). Many seem to be saying we don't want a gov't solution, we want private insurance. Then they set out to put in place policies that stop private insurance from doing what it does (refuse to write policies for really bad risks and to underwrite premiums to assing a premium based on risk). There also seems to be a general agreement that if you are going to go with a private based insurance approach that indivdiuals need to have a responsibility to sign up. As I wrote before, the difference between what Patients' Choice Act and Democratic indivdual mandate provisions in various bills seem to offer is mostly semantic in my opinion if auto-enroll procedures are robust.

Fourth, for me, the least comprehensive a bill is the more that I would want ending the employer-paid premium tax preference to go away (as it does in this bill) For me, this is a much preferred way to raise financing for any new proposal than is an income tax surcharge.

So, this wouldn't be my preferred way of doing it, but I do think Sen. Burr has offered a serious proposal.

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