President Obama signaled the start of the nation’s critical debate on health care this week by intensifying his push for Congress to get a bill to his desk by the end of the year. Senate Finance Committee members were told privately that draft legislation will emerge by June 17 and markup is expected to follow the week after.
It’s been a long time coming, but the president is riding a mandate from the election that gives him a once-in-a-lifetime opportunity to enact the first sweeping overhaul of our dysfunctional health care system since it was created almost 70 years ago.
Needless to say, the stakes are high for every American, not to mention small businesses. Small firms and sole proprietors are especially disadvantaged by our current system of employer-sponsored health care.
To make sense of the looming debate, small business owners need to focus on the current system’s twin bugaboos — affordability and availability. Their mantra should be: How will this plan make health insurance available to the 47 million Americans who are mostly gainfully employed by small businesses, yet have no health insurance? And, more significantly, how will it make insurance more affordable?
The National Federation of Independent Business (NFIB) has framed the debate around what it calls the three “Cs:” cost, choice, and competition. That’s another good way to analyze the issue once Congress produces a plan.
Sens. Edward M. Kennedy, D-Mass., and Max Baucus, D-Mont., are spearheading efforts to develop health care legislation, and they seem to be leaning toward a plan similar to one Massachusetts created two years ago. Everyone will be required to have health insurance, and a public health insurance program will be created to operate in tandem with private insurance.
In a letter to the lawmakers, Obama also threw his support behind a public health plan. He believes it would give Americans “a better range of choices, make the health care market more competitive, and keep insurance companies honest.”
But this doesn’t answer the question of affordability, which the president seemed to acknowledge. “I want to stress that reform cannot mean focusing on expanded coverage alone,” he wrote. “Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach.”
This is where the devil will be in the details. According to various reports, the legislation will include new exchanges that allow consumers to comparison shop among insurance plans. The government will step up its role in preventing chronic illnesses and create incentives to increase the nation’s supply of primary-care doctors.
To help pay for the new health plan, the administration is calling for $200 billion to $300 billion in reductions to Medicare and Medicaid spending over the next decade, the letter said. Obama also hopes to save $309 billion through reforms and by targeting waste and fraud.
In his letter, Obama said he was also open to the idea of a mandate, known as “play or pay,” requiring both individuals and employers to contribute to the cost of health insurance, even if a business doesn’t offer a health plan.