Healthcare for the Ages

March 23, 2010

David Coates is a political science professor at Wake Forest University and author of the new book, “Answering Back: Liberal Responses to Conservative Arguments.”  Here he shares his perspective on the passage of the healthcare reform bill. If you are a journalist who would like to interview Coates, email Carol Cirulli Lanham at carol@sternersedeno.com or call 972-818-0895.

By David Coates

Sunday was a good day. The House vote for health care reform was a good vote. It started us on a journey towards universal health care. It threw up a road block against some of the most egregious practices of the insurance industry. It established the principle that when you’re healthy you pay in so that when you’re sick you can take out; and that if you don’t earn enough to make that paying easy, tax dollars provided by the better paid should be used to ease that burden. Good principles – the healthy looking after the sick, the affluent helping out the near poor – a kinder and more compassionate social settlement than the one in place the day before: the one in which if you couldn’t afford to buy health care, you didn’t get it; the one in which if you became very sick, you ran a real risk of losing the very health cover you needed.

 So yes, a good day – one that will be long remembered – a good day, but sadly not a perfect one.

 The Senate bill was significantly weaker in its reforming zeal than the House bill, and it remains an open question how much of that weakness will be corrected through reconciliation. The answer is likely to be less rather than more.

  • We are likely to remain stuck with 50 state-level exchanges, not the one national one that the House bill initially contained.
  • We are likely not to find in those state exchanges any public option worthy of the name, so that the exchanges will be a site for competition only between private insurers, private insurers whose coffers will be overflowing with tax payer dollars paid over to them through the subsidies given to their low paid customers.
  •  We will have to live with the Hyde amendment enshrined into law, and extra hurdles created within the exchanges for women wishing to obtain health insurance that will give them the right to choose.
  • And even if it is a better week in the Senate than I fear, we will still remain wedded to a health care system based on profit-taking private insurance companies, one in which the main drivers of rising costs remain uncontrolled.

 So Sunday was both an ending and a beginning. It was an ending. It marked the moment when the US health care system was at last reset to give access to affordable health care to virtually all Americans. But it also was also a beginning. It set the stage for the next struggle: on how to keep that health care genuinely affordable, by addressing the inflationary forces still at work deep inside the system.

David Coates is a political science professor at Wake Forest University and author of the new book, “Answering Back: Liberal Responses to Conservative Arguments.”  Here he shares his perspective on the healthcare reform efforts. If you are a journalist who would like to interview Coates, email Carol Cirulli Lanham at carol@sternersedeno.com or call 972-818-0895.

By David Coates

This is crunch time for health care reform. The Democrats cannot afford another stalled attempt at reform. Nor can they afford another long, dragged out process of negotiation.

It is now or never for major health care reform.

The reform will not be perfect. The President does not have the Congressional numbers for perfect.

But he does have the numbers to shift the goal posts decisively in a progressive direction.

Shifting goal posts is good. If he can get us to a new system, taking us back to the old one will be politically impossible.

 The new system is significantly better that what we have now: ensuring:

  •  No pre-existing conditions
  • A health care exchange for the uninsured
  • Federal funds to help the uninsured buy basic coverage

 What is missing will need to be added later:

  •  A genuine public option and/or tight limits on what insurance companies can charge
  • Real cost reductions, linked to changes in the whole fee-for-service system
  • Even a single-payer system if insurance companies continue to misbehave

 This is the start of major health care reform, not the end. Better start with something than with nothing.

 The strategy is credible – pass the Senate bill in the House, and reform the joint bill by use of reconciliation

 But success, even on modest change, is still not guaranteed. Watch those blue-dog democrats!  Watch the Stupak amendment crowd.

 Let’s hope liberals in the House don’t let the perfect drive out the good. Snatching defeat from the jaws of victory is not sensible politics, this close to the mid-terms.

Wake Forest University offered a course this semester called “Health Care Reform:  A Sociological View of America’s ‘Non-System.’”   From preventive health to cost containment, the class has explored the fragmented landscape of health care reform from the sociological perspective.  Students who took the class are now blogging on why they are concerned about healthcare reform.

By Erin Kelly

It is just another sign of Wake Forest’s commitment to mold critically-thinking students inside as well as outside the classroom that we are able to take a class that directly addresses and critiques political reform currently taking place in America. By learning about health care reform through a sociological perspective we are learning how to analyze political theory through different view points and question the pros and cons of President Obama’s reform plan. We will be responsible for our own health care coverage very soon and Wake Forest is giving us the opportunity to decipher the complicated health care system armed with a breadth of knowledge.

Wake Forest University offered a course this semester called “Health Care Reform:  A Sociological View of America’s ‘Non-System.’”   From preventive health to cost containment, the class has explored the fragmented landscape of health care reform from the sociological perspective.  Students who took the class are now blogging on why they are concerned about healthcare reform.

By Dan Jandreau

Healthcare reform is very important for college students. Soon after graduation at the young age of 25, young adults are no longer covered by their parents’ insurance plans. If their parents do not have an insurance plan, they are possibly entering the market to buy medical insurance. After paying for college, graduates want comprehensive care at a fair price. They also do not want to be burdened with debts in the future because of ill-advised reforms made today. The U.S. is currently the closest it has been to healthcare reform. The bills on the floor are being debated by Republicans and Democrats who have vastly different views on how to reduce costs while extending coverage to more Americans. I personally feel that there are cheaper, free-market solutions to the healthcare “crisis,” but seeing as the government sponsored public option has large support in Congress, it will be interesting to see how it turns out.

Wake Forest University offered a course this semester called “Health Care Reform:  A Sociological View of America’s ‘Non-System.’”   From preventive health to cost containment, the class has explored the fragmented landscape of health care reform from the sociological perspective.  Beginning today, students who took the class will be blogging on why they are concerned about healthcare reform.

By Molly Hintz

For me, understanding and learning about health care reform is crucial now because as a college student I’m preparing myself to enter the real world. In a few short years I will no longer be under the coverage of my parent’s insurance which means what’s happening now will affect me sooner than I’d like to believe. Being active in the health care reform debate now can only benefit us; without voicing our opinions we will be living under a reformed system decided upon by the pharmaceutical industry and other big business groups who fund our politicians. As a pre-med student not only is my health insurance being debated but also my future job description and role in society.

After senior Senate Democrats reached a “broad agreement” on Tuesday night to drop the public option in favor of a compromise plan, David Coates, political science professor at Wake Forest University and author of the forthcoming book, “Answering Back: Liberal Responses to Conservative Arguments,” offered the following commentary. To interview Coates, email Carol Cirulli Lanham at carol@sternersedeno.com or call 972-818-0895.

For most liberals fighting for health  care reform, the idea of the ‘public option’ was never to put the government in the driving seat of health care provision. That claim was a piece of conservative hyperbole. The use of the public option as the thin end of a wedge that would ultimately take us to a single-payer system, was long recognized by many liberals as a non-starter, given the weight of conservatives within the Democratic coalition in Washington.

Instead, the role of the public option was to strengthen the forces of competition in the health insurance market, to make private insurance companies offer more generous and more reliable health care coverage without increasing the cost of premiums.  Conservatives pushed the public option back for precisely that reason – that it would hurt the profits of the insurance companies – by squeezing them between consumers with wider choices and a government plan with real teeth.

By steadily denuding the public option of those teeth – restricting access to the public option only to those without health insurance, and obliging the public option to negotiate its prices with health care providers in exactly the same manner as private insurers, conservatives have already seriously undermined the capacity of the public option to bring private insurers into line.

That is why dropping it in favor of tighter direct regulation of the private insurance companies through the Office of Personnel Management may indeed be the better imperfect solution.

It all depends (a) on the detail of the regulations that the OPM will set; (b) the nature of the threshold set before a government scheme can be introduced; and (c) the staying power of the OPM. If that office falls into Republican hands, the regulations can go  backwards, as all sorts of regulations did during the Bush years.

The devil here will literally be in the details. Chances are Lieberman and co. will try now to gut them of content. If the conservatives prevail, and the final bill creates a structure of regulation without potency, the fight will then be on again, to give the regulations real force.

The shell of a tighter regulatory structure may be all that can be salvaged this time round. That would be better that than nothing – giving us a framework to defend and a set of regulations to thicken. Health reform in this generation is clearly going to be a process rather than a moment!

In a media breakfast this morning, White House Office of Management and Budget Director Peter Orszag emphasized the fiscal responsibility of Senate health care reform legislation under debate. “The bottom line is the bill that is currently on the Senate floor contains more cost containment … than any bill that has ever been considered on the Senate floor. Period,” Orszag said.

David Coates, political science professor at Wake Forest University and a frequent speaker on health care reform agrees that there is no reason to panic about costs.  “Particularly in the context of this week’s CBO report that, far from escalating medical costs over the long period, the Senate bill could significantly reduce costs for many of those who now buy their own health coverage, and do so without adding to the costs of employer-provided coverage. The CBO actually thinks that, if the legislation passes as drafted, 60 percent of those buying their own insurance would qualify for federal assistance covering probably two-thirds of the costs.”

Coates adds that Republican politicians and think tanks continue to float other numbers. Cohan, Hubbard and Kessler, for instance, yesterday morning claimed that higher demand for health coverage will likely increase premiums for the typical family plan by about 10 percent (The Economists Voice, www.bepress.com/ev November); and Senators Grassley and McConnell quickly seized on the CBO prediction that unsubsidized premiums in the individual insurance market will rise by between 10 and 13 percent. “What they didn’t seize on with the same speed and enthusiasm is the likely improved content of those insurance policies and the heavy subsidization of their purchase by hard-pressed American families,” Coates says.

You can follow David Coates on Twitter at www.twitter.com/healthcarelive.

With the Senate poised to debate health care, we face a torrent of words. They will be important words. America desperately needs health care reform, no matter how set against it are sections of the political establishment. “The richest country on earth still unable to provide basic health care cover for one-seventh of its population” cannot and should not be allowed to stand. But nor should the illusion that health care reform will make America healthy. We need health care reform so that every sick American gets the treatment she or she so vitally needs; but we need far more than that. We need to put aside our tendency to require our key institutions to solve problems which we decline to solve ourselves. We ask our schools to solve problems of segregation and poverty whose origins lie deep in the way we choose to live our lives as adults.  We are now asking our hospitals and doctors to solve problems of illness that are similarly socially rooted.