Tuesday, September 08, 2009

EDITORIAL >> A health plan that will work

At long last we come to the day when everybody lays their cards on the table in the great health-care poker game — or everyone who even pretends to be a serious player. We should be so fortunate that it will end the most reckless propaganda war in the nation’s history, but we do not count on it.

President Obama will spell out the broad designs of a universal health-care plan that he would like to see in an address to a joint session of Congress tonight. To avoid what everyone thought was Bill Clinton’s fatal error in the 1994 health-reform disaster when he presented Congress with an elaborately detailed plan, Obama has been consistently vague on what he thinks would work and that he would sign into law, starting even in the presidential campaign in 2007 when he sketched the most conservative plan of all the Democratic candidates. He left it to Congress to produce the details of a plan. He said only that it should pay for itself without adding to the deficit, cover nearly everybody and curb the skyrocketing cost of health care, now far away the highest in the world.

The result of his strategy was that he was blamed for every imaginable horror that the insurance companies and right-wing broadcast gabbers and bloggers cooked up and spread across the land. There were to be Obama death panels, Obama rationing czars who would cut grandma off Medicare, Obama taxes, a gargantuan Obama deficit. Although he had not written or dictated a word of them, the voluminous bills drafted by Senate and House committees were said to be part of Obama’s plot to bury his evil designs in a sea of verbiage. At rallies and town halls, people carried signs condemning “Obamacare.” Any harmless remark of the president at a public forum about giving people choices about their care was twisted into a sinister plot to deprive people of medical care, the opposite of his purpose.

So today he will tell the country what he would like for Congress to do. There will be a real Obamacare for the foes of health reform to attack although he is almost certain to leave Congress some options on how to achieve the goals. He has telegraphed much of it. He will want Congress to mandate that everyone except the very poor purchase health insurance so that all will have access to medical attention and the vast cost-shifting to current insurance holders for unreimbursed care will end. He will want restrictions on private insurers to prevent their rescinding or denying coverage for people with chronic diseases. The government will subsidize the health policies for people with wages too low to buy it, and Medicaid will be expanded to catch more people at the bottom of the scale. People who already have health insurance would not be touched except their premiums probably would be lowered over time. Those who would be required to buy insurance could search an exchange for a policy they liked and could afford. One or more of the insurance plans in the exchange could be low-cost, government-administered plans.

Obama apparently will say, as he has in the past, that he would prefer that there be a government option to force the insurance monopolies to offer policies at competitive rates but that it is not essential. Finally, there should be mechanisms to curb the escalating costs of medical care. We hope that the president will spell out clearly what those should be. That has been the source of hundreds of fabrications and rumors, such as killing off the elderly, Ted Kennedy and Sarah Palin’s baby.

Shorn of the lies and distortions, all of that sounds like exactly what the American people have said for years they wanted.

Rep. Mike Ross of Arkansas’ Second District, who has been a key player in the development of the legislation (not positively in our view), took the occasion to announce that he would be against a government option but otherwise supportive of comprehensive legislation. He thought that the handful of insurance companies that have divided the American market could be counted on to give the tens of millions of captive new customers that they will inherit a fair and competitive price for insurance without much government involvement.

Ross, Republicans and the insurance companies have said the companies could not offer premiums as low as the government’s because the government would not have to collect money from people to cover underwriting costs or profits for shareholders and executives. They are afraid that people who would buy insurance for the first time would all buy the government policy. (Under all the bills, people and companies with existing coverage could not buy the government plan or any private plan in the exchange.)

To the extent that their concerns are real, we tender a solution for the president and Congress. Do not mandate the insurance companies to cover people with pre-existing conditions or to keep people who develop chronic illnesses, but forbid the government to deny them coverage in the public option. The insurance companies would not have to raise everyone’s premiums to cover the sickly but the government would have to set high enough rates to cover all of the chronically ill. That would give the insurance companies a huge competitive advantage on rates. It’s the American way. Shouldn’t that be all they really want?