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How Not to Fix Health Care
Discouraging developments on Capitol Hill

Friday, July 10, 2009

FOR THOSE WHO seek health reform that is effective, bipartisan and fiscally sound, the past few days have been unsettling.

First, Senate Majority Leader Harry M. Reid (D-Nev.) told Senate Finance Committee Chairman Max Baucus (D-Mont.) that his panel's plan to limit the tax-free treatment of employer-provided health insurance would not pass muster; too many Democrats would object. The ability of employers to offer unlimited health insurance to workers tax-free drives up health costs by promoting over-consumption; it benefits the well-off at the expense of lower-paid workers who are less apt to have insurance and, if they do, receive less value from the tax-free treatment of benefits. President Obama made a mistake during the campaign when he attacked John McCain for proposing to get rid of the exclusion. He is making an even bigger mistake by letting campaign positions be the enemy of good public policy.

Second, Democrats continued their insistence on a public option -- a government-run insurance plan to compete with private insurers -- as essential to effective health reform. Mr. Obama issued what amounted to a public rebuke of his chief of staff, Rahm Emanuel, for the apparently heretical act of suggesting openness to an alternative: having a "trigger" mechanism under which a public plan would be established if the private insurance market fails to provide enough competition. The president, from Moscow, restated his support for a public plan, though, thankfully, he continued to avoid drawing a line in the sand. As we have said before, it would be tragic if this issue were to drag down health reform or make it impossible to secure Republican votes. Restructuring the health-care system is risky enough that Democrats would be wise not to try to accomplish it entirely on their own.

Third, a new gimmick has been designed to pretend that health reform is fully paid for. The Senate Committee on Health, Education, Labor and Pensions adopted a measure, endorsed by the Obama administration, to have the government provide long-term care insurance in which workers would be automatically enrolled unless they opt out. Premiums would flow into the system beginning in 2011, but benefits would not begin to be paid out until five years later; consequently, over the 10-year budget window through which the Congressional Budget Office assesses legislation, the program would bring in $58 billion, according to CBO estimates. Thankfully, the committee also agreed to an amendment, offered by Sen. Judd Gregg (R-N.H.), to require that premiums be set at an actuarially sound level -- not so low that the program would end up further draining the federal treasury. Still, the money that flows in during the 10-year budget window will flow back out again. These are not "savings" that can be honestly counted on the balance sheet of reform.

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