Our View: Health bill, in sum, offers real reform

Merced Sun-Star
Dec 28, 2009

After 87 years of fits and starts, this country finally is close to extending health care coverage to most Americans. And this nation soon may be a leader not a laggard in stanching soaring medical costs.

It's so close, you can almost touch it. The House passed a bill in November; the Senate on Christmas Eve. The key elements in the two bills are nearly identical. President Obama believes "reconciling them is not going to be as difficult as some people may anticipate."

Many people have focused on what these bills do not do. It's time to look at what they would accomplish. California, and the nation, clearly would benefit.

Some reforms would kick in almost immediately. Others take time to set up and would take effect in four years.

That was true of Social Security, too. Signed into law in 1935, the first checks went to retirees in 1940.

Here is just a small sample of what's in the Senate health bill that passed Thursday:

One-third of 18- to 24-year-olds today are uninsured -- often losing coverage when they graduate from high school or college. The bill would allow them to stay on their parents' insurance until age 26. Those who don't have parents, who age out of foster care, would be able to stay on Medicaid/Medi-Cal until age 26.

Adults who lose a job or have a job that doesn't offer benefits by 2014 would be able to go to a Web site, compare plans and buy coverage through a new insurance marketplace called the "exchange." They would pay premiums based on income (no more than 10.2 percent).

Insurance companies that participate in the exchange would have to offer a minimum set of benefits. No longer could they deny coverage for a pre-existing condition or set annual limits for benefits. (Until then, the bill immediately would prohibit insurers from denying coverage to families who have kids with pre-existing conditions; it would create a high-risk pool for adults with pre-existing conditions).

Small businesses with 25 or fewer employees and average annual wages less than $50,000 would immediately gain access to a three-year tax credit. After that, they could choose to go into the exchange.

Low-income folks -- those still unable to afford insurance -- could access existing public programs that would expand in 2014 (estimated to cover about 15 million of the uninsured, including 1.5 million Californians).

The federal government would pay the full cost for those added people for three years, and after that, would increase reimbursements over current levels.

The bill also would expand community health centers, saving millions of dollars by keeping people out of emergency rooms.

The bill has no master plan, no one-time fix for reducing costs. But as Harvard surgeon Atul Gawande pointed out in a recent New Yorker article, that is as it should be.

Almost half of the bill, he writes, is devoted to programs that test "almost every approach that leading health-care experts have suggested" for curbing costs and increasing quality.

He believes this is the best way to create a long-term loop of learning among hundreds of thousands of hospitals, clinics, pharmacies and suppliers. The role of government would be to look for the best practices and find ways to get them adopted, county by county.

The Congressional Budget Office estimates that the bill would be deficit neutral and not add to the national debt. That remains to be seen, of course -- and the two houses still must reconcile how they would pay for particular items.

But the current course is unsustainable. In the end, the positives in the bill substantially outweigh the negatives. Americans should give it a chance.