Rough sailing ahead for health care reform, but it’s not our only option
The Bangor Daily News, 6/4/13
By Dr. Philip Caper, Special to the BDN
You know another storm is brewing when Washington politicians start looking for somebody else to blame for problems they themselves created.
That’s what happened recently at a Senate budget hearing when Finance Committee Chairman Max Baucus unloaded on Kathleen Sebelius, President Barack Obama’s health and human services secretary. He berated her for failing to adequately educate the public or competently implement the 2,000-plus page Patient Protection and Affordable Care Act, or Obamacare. During the hearing, Baucus worried aloudabout “a huge train wreck coming down” if the Obama administration didn’t clean up its act. Other Democrats soon piled on.
Aside from being known as one of the most prolific producers of lobbyists from among his staffers in the Senate, Baucus is probably best known as one of Obamacare’s prime architects.
Baucus is right to worry that the law may in fact run into extreme turbulence. It is far too complex. It has too many moving and interdependent parts to be smoothly implemented by anybody, no matter how talented or highly motivated, and it is too controversial.
There are a lot of people in and out of Congress — about 50 percent of Americans, according to the latest polls — who do not want to see the law implemented and will find ways to sabotage it. The law itself provides no shortage of opportunities to do so.
First, there is the challenge of setting up the health insurance exchanges in every state, when almost half the states, including Maine, have indicated no interest in doing it themselves. In those states, that job will fall on the federal government.
Then there is the law’s expansion and standardization of Medicaid — optional for each state, since the Supreme Court last year found making it mandatory to be unconstitutional. A large number of Republican governors, including Maine’s, have so far shown little interest in expanding that program.
The law also intends to expand the federal Community Health Center program. Republicans and others opposed to an expansion of government can be relied on to resist funding that program every chance they get. They will also resist expanding funding for the law’s subsidies for the purchase of private insurance.
In addition, the complexity of the law has created a huge number of unknowns. Each unknown creates plenty of opportunities for mischief in the future. Some examples: How many healthy young people will sign up for the exchanges (thus keeping premiums down for others) instead of simply paying or dodging the tax penalties? How many businesses will choose not to hire that 50th employee to avoid the mandatory coverage provisions of the law?
It now appears that federal subsidies in the exchanges may apply only to employees, and not dependents. How will this affect employees’ willingness to sign up for increasingly expensive family health insurance coverage? How will mid-year changes in employment or income affect the operation of the program and those covered by it? How will labor mobility be affected by this new system, and how will that affect the general economy?
There are lots more unknowns, but you get the idea. Complexity, not implementation, is the underlying pathology of Obamacare. Congress, not the administration, bears the brunt of the responsibility for that.
Mr. Baucus surely knew about this at the time of the law’s passage. After his own constituents in Libby, Mont., became uninsurable by private insurance due to industrial pollution with carcinogens and were unable to get the courts to hold the polluters responsible, Baucus came to the rescue. He simply tucked a little provision into the massive health reform bill making affected Montanans eligible for — you guessed it — Medicare.
No health insurance exchanges for these hardworking folks. Nothing but the best for Libby. By taking the simple, direct and most efficient route to expanding health-care coverage, Mr. Baucus did the right thing by his constituents. But Baucus made sure that everybody else had to settle for Obamacare.
It has been observed that “Americans will always do the right thing, once they’ve exhausted all alternatives.” I’m not holding my breath waiting for Congress to revisit health care reform anytime soon. But there is a lot we can do here in Maine to make health care a human right. Under the new law’s provisions we, like Vermont, can begin to move down a path to universal coverage in our state starting in 2017.
In some ways, we’re not as lucky as Vermont. Unlike Vermont, we have a large for-profit insurance presence in Maine. That means there’s a lot of money at stake. There will therefore be a lot of resistance.
But unlike Vermont, in addition to our ability to replace politicians who fail to act in the interests of the majority, we can use the initiative and referendum processes to express the people’s will directly.
It won’t be easy. But all we need is for most of us to have a common understanding of what to do and the will to do it. Are we up for it?
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at firstname.lastname@example.org.