Voters will pay a lot for reform
The White House and liberal think tanks insist that health-care reform will lower costs, but the public isn't buying it -- and for good reasons.
Practically every aspect of the bills Democrats are considering -- from covering the uninsured to taxes on providers, insurance reforms and Medicare cuts -- will result in higher premiums for those with insurance.
And unless Congress is willing to impose stricter cost controls than presently contemplated, many experts think there's little chance of "bending the curve" of national health outlays or premiums.
Moreover, while the Senate's new privately run alternative to a government-run public-insurance plan is a welcome step away from Canadian-style single-payer health care, the idea of allowing people ages 55 to 64 to buy into Medicare could be an even bigger step toward it.
And, even if President Barack Obama triumphantly signs a health-care bill, there's a political menace in it -- taxes and premiums will rise immediately, but most benefits won't be seen until 2014.
Americans generally aren't aware of that, and yet a new Quinnipiac University poll shows that by 52 percent to 38 percent, the public opposes Congress's health-care plans and, by 56 percent to 38 percent, disapproves of Obama's handling of the issue.
Deservedly, though, Republicans aren't beneficiaries of public displeasure. Voters still trust Obama more than the GOP on health care, 44 percent to 37 percent.
That's probably because Republicans have harped -- often hyped -- the negatives about Obamacare while barely mentioning positive alternatives, to the extent that they have them.
On the Senate floor, for instance, Republicans suddenly have become great defenders of Medicare -- opposing "cuts" for "grandma" -- but as Senate Finance Chairman Max Baucus, D-Mont., pointed out, the GOP for years has advocated "slowing the growth" of the program, just what Democrats are now proposing.
(Of course, when Republicans proposed it in the past, Democrats howled that they were cruelly "cutting Medicare.")
The Quinnipiac poll, like most others, shows that the public favors -- 56 percent to 38 percent -- "giving people the option of being covered by a government health insurance plan that would compete with private plans."
My guess is that the words "option" and "compete" elevate support for government-run health insurance, but in any event, it's dead in the Senate. Negotiators have substituted a system like the Federal Employees Health Benefits Program that relies on negotiation with and competition between private companies.
That should be the design for the whole of U.S. health-care reform, modeled on successful programs in Switzerland and Holland, and Republicans would be smart to propose it.
But the Democrats' new companion idea -- allowing people ages 55 to 64 to buy into Medicare -- would expand a government-run program that is already going broke.
Moreover, because Med-icare pays doctors only 80 percent of what private plans do, the plan would lead to yet more shifting of costs to private payers, raising premiums.
According to Quinnipiac, by 63 percent to 30 percent, voters think that covering the uninsured will raise their health-care costs and only 19 percent believe that Obama can keep his promise that health-care reform won't raise the federal deficit.
On health-care costs, the Congressional Budget Office projects that the Senate bill will raise premiums in the individual market by 10 percent to 13 percent but have a limited effect on workers in small or large firms.
The White House and other boosters of health-care reform, such as the Commonwealth Fund and the liberal Center for American Progress, project premium savings of $2,000 per family and reduced national health spending of $683 billion over 10 years.
But a study released by the Blue Cross Blue Shield system -- and savaged by the White House -- made a compelling case that premiums will surge by 54 percent for individual buyers and 20 percent for small firms.
That's because taxes on providers and Medicare payment cuts imposed on them will be passed on to private payers.
And insurance reforms -- such as limits on age-based premium differentials -- plus weak penalties for not being insured will give incentives for young people to go without insurance until they get sick or injured.
Democratic freshmen led by Mark Warner (Va.) are pushing to toughen cost-containment measures in the Senate bill -- now, mainly pilot programs -- but even these reforms apply only to Medicare and Medicaid.
U.S. health spending will explode, from 18 percent of gross domestic product now to possibly 30 percent by 2030, unless costs are controlled for public and private care.
The broad-based National Coalition on Health Care is calling for a "fail-safe" mechanism to reduce total spending by 1.5 percent per year -- the figure pledged by providers at the White House earlier this year.
Such a plan -- yet to be fully spelled out, let alone introduced as legislation -- might control costs. In the meantime, voters have it right: Health-care reform is going to cost and they are going to pay.
(Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.)
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