| 来源类型 | Article
|
| 规范类型 | 评论
|
| Our Kickback Future |
| John Hoff
|
| 发表日期 | 2010-01-11
|
| 出版年 | 2010
|
| 语种 | 英语
|
| 摘要 | The tactics used to force the healthcare overhaul bill through Congress despite the opposition of the American people offer the strongest argument against enacting it. If the bill passes, it will set the stage for a perpetual process of deal making, with Americans’ healthcare held hostage to special favors for powerful members of Congress and to their political whims.
The deals that Senate Majority Leader Harry Reid has made to capture the 60th vote needed to get the bill out of the Senate have provoked outrage. The “Cornhusker Kickback”—in which Senator Ben Nelson (D-NE) was induced to cast the decisive vote for the bill in exchange for a special provision excepting his state from a mandate imposed on the states to pay for Medicaid expansion—is but one of many.
Senator Reid has explained that deals like this are business as usual in the Senate. This is a defense that tells more than we want to hear. The truer it may be, the greater the outrage. To make certain we get the point, Senator Reid adds that senators who do not extract special deals for their states are not doing their job.
Enacting the bill would not end the unsightly deal making. Just the opposite. The bill would give the federal government much greater control over the healthcare sector, which would bureaucratize and politicize decisions on how healthcare is delivered and paid for. It would institutionalize and expand the scope of senators to extract special favors in exchange for their vote.
The bill will need fixing immediately after enactment because its advocates are stampeding its passage. Numerous errors will immediately become apparent, and many more will be unearthed when the government tries to implement the legislation.
Committed liberals see the bill as only the first step toward a national health system (the federal government being the sole payer). The bill keeps the insurance companies in business, but essentially turns them into public utilities. It is unclear how much value insurers would offer to the public if they are simply agents of the government. The single-payer advocates will be back to turn the regulation in the bill into government-run financing, while still labeling it as insurance.
Implementing the bill will present numerous issues—technically difficult and politically explosive. This pops out from every page of the bill: The government, for example, will divide the entire country into separate geographic areas for calculating insurance premiums. To draw these lines, the Department of Health and Human Services (HHS) will have to decide whether lower-cost communities should be included in a rating area with contiguous higher-cost ones. This is a political question of how much cross-subsidization there should be between cities and suburban areas. However HHS decides, some areas will be unhappy and will seek redress in Congress.
HHS will have to specify the healthcare services that insurers must cover, and the scope of benefits they provide must be equal to those under “a typical employer plan.” The bill lists ten categories of care that must be included, including hospitalization and ambulatory patient services. But this requirement is meaningless unless HHS specifies under what circumstances insurers must pay for inpatient care and when they can limit coverage to outpatient services. In the real world, however, it is impossible for the government prospectively to make this delineation for every patient and every health condition.
But there’s more. To make this impossibly complex exercise even more impossible, the bill requires HHS to ensure that coverage reflects “an appropriate balance among the categories” of care. It must determine what share of an insurer’s payments for care must be for hospitalizations and how much for outpatient care. Patients, insurers, and various healthcare professionals may not agree with whatever “balance” HHS imposes and will ask Congress for help.
These questions, and hundreds others like them embedded in the bill, will provide ample opportunities for tactically inclined members of Congress to extract special provisions for their states and for favored special interest groups. The more closely divided the Congress is, the greater will be the leverage for members.
The notion that decisions governing our healthcare should be made by senatorial deal making is disturbing. Business as usual in the Senate is not the standard Americans want for their healthcare.
John S. Hoff, a lawyer and trustee of the Galen Institute, was a deputy assistant secretary in the Department of Health and Human Services.
Image by Darren Wamboldt/Bergman Group. |
| 主题 | Economics
; Health Care
; Politics and Public Opinion
; Public Economics
; Society and Culture
|
| 标签 | public square
|
| URL | https://www.aei.org/articles/our-kickback-future/
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| 来源智库 | American Enterprise Institute (United States)
|
| 资源类型 | 智库出版物
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| 条目标识符 | http://119.78.100.153/handle/2XGU8XDN/248456
|
推荐引用方式
GB/T 7714 |
John Hoff. Our Kickback Future. 2010.
|
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