06/12/2009 05:12 am ET Updated May 25, 2011

A Final Hurdle to Healthcare Reform: Politicians

Last week, U.S. Sen. Max Baucus (D-Mont.) convened a hearing of the Senate's Finance Committee on healthcare reform. Familiar faces were asked to speak, like Karen Ignani, Ron Pollack, Sara Rosenblum and many others on behalf of their respective organizations (though Ms. Rosenblum is a professor of health policy at George Washington U.). No one represented advocates of a single-payer system, despite protests to the contrary. Toward the end of the hearing, Senator Baucus asked whether anyone in the room disagreed with his belief from hearing everyone that all Americans should have health insurance. You could hear a pin drop from the silence that was in response. What is strange about this question is that, of course all Americans should be covered. But the right question wasn't asked as a follow-up: who do you think should pay for this "universal" coverage? This is a significant question, since President Obama stated last November right before the election that he wants to have all Americans covered, and those who can ill afford it should be provided with what those in Congress now have. Huh? What our elected representatives have costs considerably; so, if those 45-50 million who are uninsured or underinsured can't afford health insurance now, where are they going to get the money to pay for plans just like those our elected officials have?

From the hearings before Senator Baucus it was clear that a single-payer system is not going to be the preferred route for those crafting legislation to reformat our health care system. Even in an interview with CNN on May 11, HHS Secretary Sebelius failed to respond affirmatively whether a single-payer system was a viable option. This was after Obama's meeting of the same day in the Roosevelt Room of the White House with key participants' agreement on reducing health care costs over the next ten years -- as much as $2 trillion! (Fat chance this will occur without some oversight.) When has an industry, like health care (predicted to be greater than 19% of GDP within a decade, and now over 16%), voluntarily adhered to reducing its costs without some Damoclean sword hanging over it?

While it is reported that legislation to reform our healthcare system will be introduced this summer, perhaps it is best that those writing it know what is the first question that needs to be answered. That question is, if everyone needs to be covered, how is everyone going to afford it? Politicians, listen up. Again, how are all Americans going to afford to pay for healthcare coverage -- and that includes the millions who cannot afford it now? Which gets me back to the point of why the last hurdle to healthcare reform is the politician. For every person to be covered means that there are going to be millions who still cannot afford the cost of insurance here. Surely, the private industry is not going to "donate" some of its profits to provide this coverage. That means, in turn, that there will have to be subsidies. From where? The only source is from the government, i.e., you and me, as taxpayers. So, while our elected representatives are downplaying a single payer system, and the health care industry "promises" to reduce its costs in a mighty big way, listen up all you politicians. Any reform WILL mean our government gets involved. In this regard, one of the participants at the Baucus hearing was the president and CEO of Blue Cross Blue Shield (I recall). He got it right in the sense that he thought everyone should receive some basic floor of coverage (this would be the "universal" aspect of coverage -- a concept previously written in my previous columns) with additional coverage being taken care by the employer/employee. So, while those on Capital Hill pooh-pooh a single payer system, the government will be a player in any reforms -- in which, as written here before, there will be a public-private partnership leading the way to reforming our health care system.

Finally, Obama maintains that if we are satisfied with our present coverage, it should not be stripped from us -- either because we like the benefits and/or because we also can afford it. Great. "If it ain't broke, don't fix it," as a once powerful mayor of Chicago was said to have spoken a long time ago. Obama also has it right when he knows a new system will only come into being over a matter of time and not immediately, and that he looks to those in Congress to craft his health care reform legislation -- the latter is precisely what President Johnson did when he wanted senior citizens of the time covered; that became known as Medicare. Nonetheless, that first question our politicians have to realize when reforming health care will be, whose pocket will be entered to pay for the millions that cannot afford medical care and treatment today? The answer again -- Uncle Sam.