Expand Coverage----AND Control Costs? How To Do That?

By Steve Schulte of
Health Advocate Solutions

A REFLECTION: (written previously)

I have long been a fan of the "robust public option".

Two reasons: if properly done this public option would inject badly needed competitive forces (think: rain in the Sahara Desert....)into the healthcare market place. It would also create a platform for best practices to be imposed upon a balkanized, unruly and highly inefficient market.

Pretty strong, I know. But we as Americans need healthcare reform---including expanded coverage---so badly that anything less would be acceptable.

The dance in the U.S. Congress has been pretty intriguing as well as hard to follow over the past few weeks.

Just yesterday (12.8.09) a committee of 10 Democrats (Republicans seem bent only on destroying any chance for meaningful reform in real time)apparently recommended a yet NEW permutation of the concept of "public option". The result of their negotiations has been submitted to the the Congressional Budget Office (CBO) for a financial reality check.

So, in an attempt to keep track, let's review. In late summer the House passed a strong public option plan with their legislative proposals (three). Good so far. However, the House plan raised a couple of primary concerns. Would it really be an option since only about 15% of the currently uninsured would have access to the plan? And, would it control costs---or just EXPAND already expensive healthcare coverage?

The Senate then got bogged down in a process of searching for 60 votes that would pay homage to a "public option". This created a liberals versus moderate Democrats drama for several weeks. (Abortion funding was a sideshow.) Reminder: Republicans were not playing here. Except perhaps for Senators Snowe and Collins from Maine.

With the outcome increasingly uncertain Majority Leader Reid convened his committee of 10. He exhorted them to find a compromise that could muster the desired 60 votes. Needless to say, a pretty tall order.

What the committee has apparently recommended (since we don't yet know for sure) includes an expansion of Medicare for those 55 to 64 and an expansion of Medicaid so that it would incorporate a broader income swath. That is, people with incomes significantly above the poverty level could qualify. Certainly federal subsidies would be required to expand both programs to new legions of uninsured and unemployed. Thus, the CBO report's keen importance.

If my facts are accurate to this point, several questions bubble up.

Do we still have a "public option"? Will a greater number of senators expand an expansion of current (successful) programs to cover some of the uninsured? Will expansions of Medicare and Medicaid control costs and raise quality standards for care delivered? Will the new compromise meet Obama's goals of covering more Americans and not adding to the current deficit? What will liberal House members do in response? Remember: any Senate agreement must be reconciled with House proposals before a final bill can be presented for the President's signature.

So a LOT rides on reconciliation.


To respond to this blog, email steve6schul@yahoo.com