Wednesday, January 20, 2010

Jury Duty

I have jury duty on line ability. Managed to stay away from sharp objects and ledges over night....

The unsustainability of our health system hasn't changed but the politics sure have. By unsustainable, I don't mean that it sucks. I don't mean that I wish we could copy another nations system. I do mean that we cannot maintain fiscal sanity over the long term with no change in our health system. By fiscal sanity, I mean the ins (taxes) have to match the outs (what gov't spends). We have no hope of fiscal sanity without health reform. The Peterson-Pew Commission (Center right) and the Center for budget and policy priorities (Center left) recent reports are just about the same report. Deficit reduction long term = health care reform. You cannot have one without the other.

I think the country would be better off if the House passed the Senate bill. Not because it would guarantee fiscal sanity. Indeed, if it were the only thing done, it would not. However, if it were passed, it would be a start to a path that got us there, and its passage would ensure that we would have to tinker and address the system for the next 5 Congresses. Sort of like hand cuffing everyone to everyone else and jumping off the cliff. But, they are not going to do that.

I heard some folks on TV saying things like 'pass the popular parts' like banning pre-existing conditions and nothing else and claim victory. That won't work as a health unsustainable as the current system is, you could make it worse. Something like this (ban pre-existing but allow underwriting which means astronomical premiums, or ban both without a mandate) would likley just devolve an already small and fragile nongroup purchase market into death spiral. The cannablized parts don't make so much sense in a vacuum.

So, the Dems either need to cowboy-up and pass the Senate bill or step back and work a plausible, relatively comprehensive plan. You could just give up, but while it is possible the Dems could lose the House anyway, I think it is probable if they fail to address health care at all.

If you are going to step back, it is not to the start, there have been lots of talks. If doing this, start with malpractice reform. It will not save that much money ($54 Billion over 10 per CBO) but hey, it will save some. And, most people want that. This is a case where doing what most people want will likely help some, and at least won't do anything really bad.

And for the Republican politicians with plans that would repeal the tax exclusion for employer paid insurance (Bennett of Utah, Burr, Coburn, Corker, McCain) in the Senate, please talk your plan up. There is plenty to criticize in them (Bennett's is actually with Wyden which is why he is being primaryed in Utah), but you have it right that the tax exclusion remaining unlimited hinders our ability at slowing health care inflation. The President has obviously been convinced that the tax exclusion is a long run cost problem as he managed to keep the high cost tax in the negotiations of last week. You can choose to focus on the deal Labor got, but I was surprised the tax stayed in. Tangling with labor like that would be like if a Republican said 'well, maybe abortion is not that bad' in terms of taking on a key political base.

If the Republicans jumped in, they could help move this along and perhaps move it away from a tax that is a de facto capping of the exclusion, and maybe we could have an actual capping of the exclusion that would help focus on the role of the individual in rising health care costs. Maybe their plans are all defensive, just to say, yeah we have a plan. However, even this morning I saw some of them saying we need to address the health system problems. You could choose to wait until after the election, thinking you will have much more power. If you started now, it might actual improve the chances that turned out to be the case.

And go from there. Back to jury duty.

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