For those who have long pushed for government to do something to help the growing number of uninsured Americans, the current pullulation of proposals is both surprising and heartwarming. Equally stunning are the strange nexuses of interest groups involved. Who would have thought you would see Big Labor, AARP and the Business Roundtable sharing one healthcare podium, and physicians, hospitals, insurers and the Chamber of Commerce another?
As with any healthcare reform, unfortunately, its the something that matters. There are some vaguely common themes in the plans, but not enough to suggest a strong enough consensus has emerged to get something passed and signed into law this year. Mucking the waters further is the fact that during his upcoming State of the Union address, President Bush is likely to introduce more tax cuts to lure even more people into the netherworld of individual insurance.
To be sure, last week saw a breathless barrage of ideas. The newly christened Health Coverage Coalition for the Uninsuredwhich includes the American Hospital Association, Catholic Health Association, American Medical Association, Americas Health Insurance Plans, Families USA and U.S. Chamber of Commercecalled for a system to dramatically increase enrollment in current federal healthcare programs for the poor and new tax credits to help low-income people above the poverty line buy private health coverage.
Sen. Ron Wyden (D-Ore.), backed by the Service Employees International Union and some employers, gave new details on his individual mandate plan, which would end employer-based coverage. Health plans would have to compete for business with new statewide agencies, which would ensure coverage equal to or better than what is available to federal employees. The measure would establish community rating nationally, and plan members would be given breaks on premiums in exchange for healthier lifestyles.
Meanwhile, Sen. Edward Kennedy (D-Mass.) stumped for his expansion of Medicare to all Americans, regardless of age, starting with people aged 55 to 65 and those younger than 20. And yet another coalition, including the SEIU, Business Roundtable and AARP, said it would put pressure on Congress to achieve consensus on expanded coverage and controlling costs, though it did not back any specific bills.
The states are much farther down the road toward action. In more than half the states, healthcare reform was on the agenda of newly sworn-in governors. Massachusetts has already embarked on its individual insurance mandate. California Gov. Arnold Schwarzenegger has come up with a sort of HillaryCare Light, a convoluted mix of employer coverage and an individual mandate, with an array of fees and taxes on providers and small employers. In its current form, it is going nowhere, but he may have started the ball rolling toward negotiations on legislation that would. And Pennsylvania Gov. Edward Rendell last week called for a basic health plan for the uninsured (with another individual mandate) funded by modest taxes and health-cost reductions from reducing medical errors and managing chronic illnesses.
At the federal level, the many proposals seem to lack cohesion, but the quality of the new alliances and the new ideas they have generated may have provided a jump-start to an issue that seemed moribund only weeks ago. Employers and the public may have reached a tipping point, pushed by the continued rise in premiums, copayments and deductibles.
Questions remain on whether one plan will begin to build momentum and whether a leader will emerge to push it through to passage. The feeling here is the answer is no on both scores, and that real reform will happen only at the state level for now. Perhaps a state can provide the real-world demonstration for a national plan that Congress could adoptafter the 2008 elections.