Topic: Political and economic
As those who have read much of this blog know, I have long supported national, single-payer health care. Nevertheless, I support the president's proposal for two reasons:
1) I have committed myself to support the President personally, as far as good conscience allows, for the good of the country, as explained in earlier posts on this blog.
2) I remember what happened to Hillary Clinton's health care reform proposal, during Bill Clinton's first term as President. At the beginning of the Clinton administration, there was a fairly strong national consensus in favor of health care reform. Mrs. Clinton proposed, with her husband's support, a plan that would have been a great improvement over the status quo, though it stopped well short of single-payer national health care (although the enemies of the plan accused her of proposing this). But several other proposals also had strong support in Congress. During the year or so that the supporters of reform were arguing among themselves about which plan to follow, the health insurance industry was able to mount a successful public relations campaign that completely derailed any reform. So, because the supporters of health care reform could not agree quickly on the details, we ended up with NOTHING.
I've explained my misgivings about the direction the President plans to take--mandatory private health coverage--in previous blog entries. Greatly summarized, they are:
1) If individual payment of health insurance premiums is to be mandatory, what is to be the penalty for failure to pay? A fine (wholly unrealistic if the problem is self-perceived inability to pay)? Prison time (which appears to be a self-defeating penalty, as it destroys the ability to pay)? Commitment to a mental institution? Seizure of property to pay past-due premiums? Random capitol punishment by death in a medical emergency?
2) Are insurers to be left free to rate policies as they do now? Do self-employed individuals and individuals whose employers escape the requirement to provide coverage still get the highest premium rates--only now compulsory rather than discretionary? Will individuals with pre-existing medical problems now simply be required by law to pay whatever premiums the industry demands of them? Do small employer groups remain small employer groups? Or are we to move toward community or national rating (which seems much more fair if payment of premiums is to be required by law)?
3) Will the formulas for premium subsidies be realistic? Government income formulas never are. Will the formulas take into account other types of debt that the law highly favors for payment, such as child support and student loans (both of which have strong enforcement mechanisms and virtual nondischargeability in bankruptcy), mortgages, and credit card debt. I recognize that, if a person cannot simultaneously make all legally favored payments and eat, he or she must stop eating and make the payments. But if a person truly cannot simultaneously make all of his or her legally-protected debt payments and the mandatory health insurance premium payment, which debt must yield?
I trust that Congress will be able to address these problems before the final markup of the bill, and that it will act quickly to make the reform a reality.