My impression of CNN is that they are often not all that sympathetic to conservatives and "cheerlead" the liberals. But in this piece with Zakaria, a "fair and balanced" tone is struck.
He hits on some items that really got overlooked in the debate prior to the bill's passage
Excerpt:
Zakaria: Eighty-five percent of Americans have health care and 15 percent don't. For that 85 percent, the great health care crisis is spiraling premiums and out-of-control costs, and so the question is what is the mechanism by which you can bring costs down? There are basically two ways -- either you use a market mechanism, which is that the consumer of health care has to pay more of the costs and therefore that direct link between the consumer and the costs will force costs down. The consumer will exercise his buying power the way he or she does with every other good.
The second method is through some kind of government control or rationing of the process. And that's inevitable in a system where 50 percent of all health care is paid for by the government.
CNN: And the other mechanism, the market mechanism, how would that work?
Zakaria: To really make that work, you would probably need to get rid of the tax subsidy to employers. .... Companies that provide health care to employees get a huge tax deduction that costs the government $250 billion a year. We as consumers really have no idea of what the services, the X-rays, the doctor visits cost. As a result, there's an incentive for costs to really spiral up, because the consumer really doesn't know what they cost and doesn't ultimately really pay for them.
I hate to use the word comparison shop when talking about health care because it's not quite like buying a flat screen TV, but still there is a reality that the information in the system is so shrouded in mystery. Most people don't know what a CAT scan costs but would think nothing of going in to get one and demanding to get one if they have a severe headache.
Anything that makes you more aware of the price, and makes you exercise some choice in terms of where you get the services would likely rationalize the system and take unnecessary costs out of it. ...
CNN: Is there anything in this bill that accomplishes these two objectives?
Zakaria: It's sort of a glass half full, glass half empty situation. There's more in here about cost controls than in any previous expansion of health care since the creation of Medicare. But objectively you'd have to say there isn't a lot.Zakaria deserves some credit for a sober assessment instead of blindly accepting the claims of the Democrats that this bill is the greatest thing ever.
As it is, insured people fall into the following categories:
1. Covered by Medicare (government option for seniors)
2. Covered by insurance as an employment benefit (paid for with pre-tax dollars)
3. Covered by individual insurance purchase (paid with after-tax salary dollars)
4. Covered by Medicaid (government option for low income)
Uninsured people fall into these categories:
5. Want to buy insurance but don't have enough money but not so poor as to qualify for Medicaid
6. Want to buy insurance but denied due to pre-existing conditions
7. Choose not to buy for various reasons
As it is, group 2 often have less options because the company might not offer many health plans but it is paid for as part of the job with pre-tax dollars.
Group 3 have more options buying in the individual market but it costs more and is paid with with taxed salary dollars.
If health benefits were taxable, the disparity between group 2 and 3 would be reduced dramatically to the benefit of both groups.
A health insurance tax deduction should be offered to help people in group 2 and 3 to get insurance. And it has the added benefit of providing a financial incentive for those in group 7 to stop being "free-riders" because they can only capture the deduction by getting insurance.
Ending the practice of denial due to pre-existing conditions would help group 6 but without the health insurance tax deduction that addresses group 7, there could be free-riders hiding in group 6.
Offering tax credits/vouchers directly to help people in group 5 makes sense and I agree with that part of the new health bill.
What I don't like is how the new health bill tries to pay for it with a mish-mash of taxes and fees on narrow groups and employer penalties rather than a broad based tax on the principle that if all benefit, all should pay.
The mandatory state level health insurance exchange (HIE) systems should have been made optional. The Massachusetts experiment with HIE has had mixed results. States should have been given the flexibility of trying an HIE or permitting sale across state lines without an HIE or some combination of both. As states gained experience using HIE and non-HIE approaches, the concepts could be refined and best practices could be identified.
So the new bill has some good intentions and helps group 5 but there are some flaws in funding and implementation and it is missing key elements to address the problems of people in groups 2, 3, 6 and 7.
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