Crunch Time
A story in today's Wall Street Journal talks about the hospital and insurance sectors preparing to fight the latest Congressional efforts to reduce or eliminate penalties for individuals who do not purchase health insurance, on the grounds that it will mean millions of individuals, many of whom will be healthier young adults (the "invincibles"), going without coverage. Hospitals contend that their industry's agreement to accept lower reimbursement from the government in order provide funding to cover the uninsured was conditioned upon insurance mandates to assure that all patients would have insurance coverage. The insurance companies' willingness to support guaranteed issue for all applicants was based on having universal required coverage as well, so people cannot put off buying insurance until they became sick, an insurer's nightmare about guaranteed issue.
We have been hearing recently about the union opposition to taxes on "Cadillac" insurance plans, too, as the realization sinks in that these high-benefit plans are more prevalent in collective bargaining agreements than in most businesses. In short, the more the details of proposed legislation become known (and it is still rare to find anyone who has been struggling through the various versions of the draft bills, all of which are in the 1000-page range), the more the special interests are surfacing to defend their turf and fight anything that will negatively change their worlds.
Health care reform sounds good to everyone in the abstract. There are even some pieces of the puzzle that most everyone seems to agree would be good, mostly things that require little additional funding and little federal regulatory control. Trying to fund hundreds of billions of dollars in new commitments in a budget neutral way means somebody is going to have to pay more, and adding scores of new government commissions and regulatory bodies to control the insurance industry and the delivery of health care services means some people's livelihood and careers are going to be disrupted or marginalized. An open debate over these issues would mean a fight in Washington like we haven't seen in some years, as there is more at stake when you are making radical changes to 16% of our economy. Is there any wonder that Congress prefers to deal only with vague 200-page "plain English" summaries of the massive changes they are considering? I don't think we have even seen the start of the battle. It will be an interesting Fall.
