PERSPECTIVE FROM THE 19TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon (Les AuCoin), as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write. I could have called this blog “Middle Ground,” for that is what I long for in both politics and golf. The middle ground is often where the best public policy decisions lie. And it is where you want to be on a golf course.
NOTE: This is an old health care blog, but one worth repeating. Plus, in light of the fact that ObamaCare now exists and has done some good work, a point I make below is that now is the time to work to improve it, not work to toss it out. And, as I write this, the confirmation process for Supreme Court nominee Amy Coney Barrett is under way in Washington, D.C. ObamaCare has been a central tenet of that process illustrating that Democrats believe Barrett wants to gut the law. To her credit, Judge Barrett, appropriately, has declined to predict how should would rule on such a case when one comes to the Court, but she also stresses she is not an enemy of ObamaCare.
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One recent news development prompts me to go into my “archives” (no, there is no real archive, just my own random files) to see what I wrote about health care many months ago.
As mentioned in the note agove, the development is the confirmation hearing for the nomination of Judge Amy Coney Barrett to serve on the Supreme Court. Critics on the Senate Committee conducting her confirmation hearing have tried to paint her as a direct threat to ObamaCare, earlier known as the Affordable Care Act.
Other issues have been raised – especially abortion – but the future of ObamaCare has been central to proceedings.
As I watched much of the process on-line (remember, I am retired, so don’t have much else to do), I found myself marveling at Judge Barrett’s ability, with skill, distinction and honesty, to avoid traps laid by some Senate Democrats. They wanted to depict her as an enemy of health care by getting her to commit to getting rid of ObamaCare, and she would have none of it.
So it was that I went to my archives.
A number of months ago, under this headline – What Could Constitute Middle-of-the-Road Health Care Reform – I wrote that I felt it was important for me to have suggestions about reform, not just criticisms of ObamaCare.
I also said a country such as ours, with all of its various political viewpoints, should be able to solve a challenge such as what to do about health care for Americans. A solution can emerge if, in contrast to the Obama Administration as it developed what came to be called ObamaCare, or in contrast to Republicans in Congress who have no alternatives, the goal is to produce a program somewhere in the middle, not one adopted by only one side or the other.
In today’s confirmation hearing, Senator John Cornyn, the Republican from Texas, put it very well when he said Congress – and he included himself in his indictment – had not done its job well by producing ObamaCare law. In fact, he said Members of Congress don’t even see legislative language as they delegate the writing task to staff.
If, he contended, Congress had developed the exact language of health care policy and set out to build a strong and bi-partisan consensus for it, health care policy would not be as contentious as it is today.
For that failure, he blamed both Republicans and Democrats.
All parties should endeavor to do what did not occur with ObamaCare, which was developed by one side behind closed doors. The plan gave bureaucrats control of health care and represented, to many, the irst step down a slippery slope toward a single payer health care system that would bankrupt the federal treasury, if it is not already bankrupt.
Senior Democrats crafted ObamaCare in backrooms, foregoing hearings, markups, even input from their own colleagues—much less Republicans. And the final vote was taken even before many of those who voted had even read the legislation.
It’s time for something different, a middle-of-the-road plan that takes into account perspectives from reasonable folks on both sides of the aisle in Congress – and, yes, there are some, perhaps a minority, but “some” nonetheless.
And, I believe the middle ground solution should include involvement from government and the private sector
If Republicans in Congress would participate in an effort to produce solid reform, instead of just carping about ObamaCare, our country would be better for the effort. That would require a change of heart and mind on the part of Republicans. Work toward the smart middle instead of just saying no routinely.
And, of course, Democrats would have to participate fully in the process.
So, borrowing, in part, ideas from the American Enterprise Institute, not just my own notions, here are what I called several months ago “four legs of the health care stool.”
1. It won’t be popular in some quarters, especially with some Republicans, but, first, a critical component of reform is to require all citizens to have health insurance, either by buying it if they can afford it, or by having it provided by government if they cannot.
Without everyone in the to-be-insured pool, any system will collapse. The very rationale for insurance is that the largest pool possible should be covered in order to spread the risk.
THINK OF IT THIS WAY. ALL OF US WHO DRIVE CARS ARE REQUIRED TO HAVE AUTOMOBILE INSURANCE. IF WE DON’T, WE PAY A PRICE. THE SAME POLICY SHOULD EXIST FOR HEALTH INSURANCE.
2. Second, a catastrophic health insurance plan should be provided so that those who cannot afford regular insurance have an option for a lower-cost plan.
As the American Enterprise Institute has written: “Health insurance is also important for financial security. The ObamaCare replacement should make it possible for all people to get health insurance that provides coverage for basic prevention, like vaccines, and expensive medical care that exceeds, perhaps, $5,000 for individuals.
“Those Americans who don’t get health insurance through employers, or Medicare and Medicaid, should be eligible for a refundable tax credit that can be used to enroll in a health-insurance plan. The credit would be set at a level comparable to the tax benefits available to individuals with employer-sponsored insurance plans. The subsidy would be enough to make a basic level of catastrophic coverage easily affordable for all Americans.”
3. Third, any new middle-of-the-road health coverage approach should accommodate people with pre-existing health conditions.
I have mixed emotions about this because, inevitably, the price of insurance will go up with the added risk of covering pre-existing conditions. Yet, there is a reasonable social consensus that people should not be penalized financially for health problems largely outside of their control. And, I support covering pre-existing conditions even if it costs me more money to do so.
4. Fourth, any new plan should allow broad access to health-savings accounts (HSA). ObamaCare pushed millions of Americans into high-deductible insurance without giving them the opportunity to save and pay for care before insurance kicks in. There should be a one-time federal tax credit to encourage all Americans to open an HSA and begin using it to pay for routine medical bills. And HSAs, combined with high-deductible insurance, could be incorporated directly into the Medicare and Medicaid programs.
As millions of consumers begin using HSAs, the medical-care market will begin to transform and deliver services that are convenient and affordable for patients.
While I am not advocating this specifically as part of my proposal, I believe consideration also should be given to deregulating the market for medical services.
As I wrote above, HSAs will empower the demand side of the market, but suppliers need freedom from overly-aggressive regulation to provide packages of services better tailored to individual needs.
Hospitals and physicians should also be allowed to sell access to their networks of clinics, oncology services, and inpatient facilities as an option to be used in the event a patient is diagnosed with an expensive illness.
American health care is teetering because it relies too much on government mandates and funding. Along with government health care, including Medicare and Medicaid, a functioning private marketplace can deliver high-quality care at lower cost.
I hope those involved in Congress and the Administration will move to consider real health care from and then build consensus behind it . At the same time, because ObamaCare is in place, the best solution is to build on it, not tear it down.
Now is the time to develop a system that empowers consumers to take more responsibility for their own health care and that of their families. A political approach from the middle is the only way to achieve acceptable, long-term reform.