This editorial will appear in tomorrow’s print edition.
It’s fitting that the U.S. Senate is poised to approve historic health care legislation during Christmas week. Like a big present under the tree, the package looks gorgeous, promises to run up the Visa card and conceals things known to only a few.
But shaking the box tells you quite a bit. The immense bill would extend coverage to most Americans now uninsured, require all individuals to carry medical insurance (subsidized as necessary), and prohibit insurance companies from refusing to sell coverage to the sick or dropping them after they get sick.
This is good, as far as it goes. In a humane society, access to health care is a moral imperative. Americans should not die because their wallets can’t get past a biopsy at the front desk.
And the law must demand that individuals carry coverage. The logic follows mandatory auto insurance: If you don’t insure yourself, you are effectively planning to dump your expenses on someone else. Those who think this violates their rights ought to pledge in advance not to accept care from a doctor or hospital unless they pay full freight. Any takers on that bargain?
One of the big mysteries in the Senate’s box is the bill’s ability to control health care costs in the real world.
In this respect, the Senate legislation beats its House counterpart. Both this bill and the already-approved House version would raise much of the $1 trillion cost (over the next 10 years) by raising taxes on high-income Americans. But the Senate bill also sticks a whopping 40 percent surtax on the most generous health insurance plans. This is essential: By shielding individuals from the real costs of their treatment, such Cadillac plans encourage unnecessary medical procedures.
For the insured, there’s little correlation between quantity of care and quality of care – and non-essential care is a big reason for the country’s ruinous health care costs. Anything that forces Americans to think hard before running up a tab for elective procedures and prescriptions of marginal value would be a good thing.
The big question is whether the seemingly hard decisions embedded in this legislation would actually stick. For example, the single biggest source of savings in the package comes from $500 million worth of economies in Medicare.
There’s plenty of bloat in Medicare, but any attempt to trim it has always elicited a large collective scream from the program’s beneficiaries.
The same goes for other provisions designed to curb unnecessary care. It’s simply impossible for even hypochondriacs to get all the treatment they think they ought to have. There must be limits – but heaven help the people who try to enforce them.
This package may well contain lumps of coal. The system it would create will collapse under its own costs without fiscal discipline. But the chronically uninsured – the Tiny Tims of America – should be very happy about their present from the Senate this Christmas.