By David Lazarus
January 9, 2012, 4:43 p.m.
It’s wrong to call the president of the United States a weenie. So I’ll just say instead that perhaps President Obama could show a little more spine when it comes to healthcare reform.
Sure, he flexed his muscles last week with the recess appointments of new consumer and labor regulators. But on the healthcare front, Obama has backed off from a “public option” for people who don’t receive coverage from their employer.
U.S. healthcare spending rises 3.9% in 2010
He’s settled for extending health insurance to an additional 30 million people when in fact the number of uninsured is closer to 50 million.
And now the president has apparently decided to avoid a bruising fight over how much coverage insurance companies should provide, and at what price, when so-called online exchanges open for business in 2014.
Rather than have the federal government guarantee that certain standards for policies and pricing are met nationwide — ensuring that all Americans receive equitable coverage no matter where they live — the White House says it’s content to let each state call its own shots.
“Our approach will protect consumers and give states the flexibility to design coverage options that meet their unique needs,” said Kathleen Sebelius, the secretary of Health and Human Services.
It might do that.
But it might also create regulatory confusion as healthcare standards potentially differ in all 50 states. It might give businesses more clout in lobbying to offer as little insurance to employees as possible. And it might squander the savings that could come through consistent coverage and pricing on a nationwide basis.
“You can be a Jeffersonian and say that states would have a better perspective on what people need in a benefits package,” said Mark Pauly, a professor of healthcare management at the University of Pennsylvania.
At the same time, he observed, “the federal government may have more countervailing power against special interests than the states.”
So it comes down to the same ideological divide that’s characterized the healthcare debate from the start: whether the federal government is in the best position to make sure everyone’s covered, or whether this is best left to local authorities and the marketplace.
To me, that question has already been answered. The failure of local authorities and the marketplace to provide affordable and accessible health coverage is clearly demonstrated by the tens of millions of people who lack health insurance in the richest, most powerful nation in the world.
And for those who do have coverage, chances are they’re paying more for medical treatment than people in other developed countries.
The United States spends about twice per person for healthcare than the likes of Germany, France and Britain, according to the Organization for Economic Cooperation and Development. Yet our life spans are shorter and our infant mortality rate higher.
For all the talk among conservatives about the U.S. healthcare system’s being second to none, those are some pretty eye-opening data points.
Ours is one of the few developed countries without a healthcare system that guarantees coverage for everyone. A Medicare-for-all system would address this, but Obama decided not to take us down that road.
He went instead with prohibiting private insurers from turning people away, regardless of their medical condition. To prevent people from waiting until they get sick before buying insurance, Obama introduced a requirement that most people have coverage.
That requirement is now under attack by Republican state attorneys general. The Supreme Court is scheduled to hear arguments in March on whether Congress can impose such a mandate.
Apparently as a sop to live-free-or-die tea party types, Obama has now punted as well on the exchanges intended to provide a level playing field for people seeking insurance. Rather than creating a national framework for coverage and pricing, he’s content to hand that authority to the states.