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Aaron E. Carroll

Aaron E. Carroll

Posted: March 15, 2010 10:04 PM

Yes, the Bill is Imperfect. Pass it Now.

What's Your Reaction:

Pass the bill. There -- I said it.

Before you start screaming at me from the Left, take a deep breath. My bonafides on robust reform are pretty solid. I've published research, more than once, on how physicians are pretty receptive to national health insurance. I've previously been on the board of Physicians for a National Health Program. I even appeared on the Colbert Report last summer to talk about single-payer health care. I'd rather have that; we're not going to get it right now.

They should pass this bill.

Before you scream at me from the Right, I know this bill isn't perfect. I agree that it doesn't do enough for cost containment (although sometimes I think that I am much more sincere about really containing costs than you are). I agree that there are parts of it that aren't entirely clear. But most of what you seem to hate about the bill isn't actually true. So it's hard to know what to tell you.

They should pass this bill.

Whenever you debate a medical treatment or procedure, you have to weigh the benefits versus the harms. If the harms outweigh the benefits, it's probably not a good idea. If the opposite is true, it's a path you likely should consider. And when it comes to this bill, I think that it does more good than harm, if only for the following reasons:

  1. Severely increased expansion of Medicaid. Few people know how limited Medicaid coverage is. In most states, you can't get Medicaid at all if you don't have kids. And even if you do have kids, some states limits are so low that if you're part of a couple with two children and make $2500 a year, you make too much to get Medicaid in Alabama. The Senate bill raises the limits for everyone in the country to 133% of the poverty line. That's a big deal, and would do an amazing amount of good for millions of the least well off among us.
  2. Increased regulations on insurance companies. They can't deny you insurance for pre-existing conditions. They can't stop paying the bills at some arbitrary limit. They can't charge you more because you (or your child or your spouse) were unlucky to develop a chronic condition like diabetes, asthma, or cancer. They can't drop your coverage when you get sick. They can't spend more than a certain amount on things not actually relevant to health care.
  3. Insurance exchanges. People who get their insurance through their jobs have absolutely no idea how difficult and expensive it is to get insurance in the open market. And know this - you're one layoff from being in that position. Just ask the UAW member, the steel worker, or a local contractor. The exchanges will let everyone, absolutely everyone, be part of a large group to get insurance. I don't know anyone who opposes this.

And there's more. There's money for federal Community Health Centers, which serve over 16 million people and likely more in the future. There's money for increased training of primary care providers. And - it's projected to decrease the deficit, unlike Medicare Part D, passed by many of the Republicans and Democrats who've now suddenly become averse to spending, which will add about $1 trillion to the deficit over the same time.

Yes, it's not completely universal. I hate that. It still supports the massively fractured health care system we all seem to loathe. It won't do much to change our culture of massive over-spending. It won't do enough to truly rein in costs over time. It's not as efficient as it could be and still tolerates an enormous amount of waste.

Still. They should pass the bill.

The good it will do is far better than the status quo. It improves the situation for millions of people without insurance. It helps everyone who doesn't get insurance through their employer. It provides security even for those who do, and might someday join the ranks of those who don't.

But there is one more reason to pass this bill. It's an argument I use even when talking to my friends who vehemently oppose it.

If they don't pass this thing, then no one - NO ONE - is going to attempt to fix this at all in the foreseeable future. And one thing you're hearing as a scare tactic is true. We are spending almost $2.5 trillion a year on health care. It is 16% of our economy. And it's growing too fast. If no one touches this, then we're doomed, fiscally. Costs will continue to rise, politicians will put it off, and we will crash. Then, when we have to fix it, there will be nothing left to fix it with.

We need real cost control, and the only way to do that is to build on this. There needs to be a success to build on. We need to get everyone covered. We need to improve quality. We need to make it even more efficient. And all of those things require some momentum, or something to convince future politicians to act.

Moreover, to truly contain costs, we will need to take more drastic action someday soon. If you think this iteration of reform is unpopular, wait until you see someone honestly try and talk about reining in spending. That will work if - and only if - it applies to everyone equally; it will work only if everyone is covered.

And none of that will happen if they don't pass the bill.

So pass the bill.

Read more about health care policy and get your questions answered at Rational Arguments.

UPDATE: It's important to note that in this piece I am speaking for myself, as a private citizen, and in no way representing my University or any other organization.

 
 
 

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