Who Pays For Health Care Reform?

Health Care reform no matter what form it takes is an expensive proposition. It is being reported today in almost every major news source that the Obama administration is considering a more hands on approach. One that has been described as more prescriptive of his ideas for health care reform by David Axelrod. This more prescriptive approach seems to be designed to take advantage of President Obama’s ability to sway the public by appealing with oratory and passion rather than logic and compassion. So what are the alternatives – and how will the great Financipator pay the bill?

First, Obama could take a step back. Obama could drop plans for the public option and/or insurance cooperatives and keep the requirements of: health insurance reform, an individual insurance mandate and government subsidies to individuals to purchase insurance. Preventing insurance companies from denying coverage to people with preexisting conditions or charging higher rates based on medical condition would let people buy insurance when they get sick and give them no reason to buy it when they are healthy, making the whole system unsustainable. Advocates of this option admit that everyone would be forced to pay into the insurance market through a federal requirement, while those with lower incomes would be enabled to buy coverage with a subsidy.

Since the main public concern is spending this option doesn't fix anything. No matter how you figure it universal insurance coverage is expensive. Even squeezing the subsidies makes only marginal difference in the overall cost.

Second, Obama could abandon universal coverage and concentrate on health-care access for the poor and working class by expanding Medicaid. This option could be somewhat controlled because it expands an existing federal program. And because this option expands an existing federal health-care role instead of creating one, it may be less scary.

Again the question becomes who pays for it. Medicaid is not fully funded by the federal government. The cost for the Medicaid program is shared between the federal and state government. Longer term who would sustain it? The American people as a whole? Or the residents of a state - which could cripple economy of some states struggling to fund their Medicaid programs today.

Third, Obama could propose a plan that is seriously designed to reduce the COST of health care, rather than simply trying to find a way to nationalize the system. Serious looks at tort reform, the medical supply and pharmaceutical industries might be a start.

Instead this administration continues to press onward with proposals in which they have invested less time than the selection of the family dog. But - As we know winning is everything. There is no real desire to reform anything except the health care delivery system. Who will pay the bill? We will, our children will and generations to come will. This bill will be paid for with increased taxes and declining access to care. But hey - the Democrates won the election on change and they never claimed the change would make us happy!