Health Care: True change is in proposal’s details

We spend too much on health care in the United States and get far too little in return. On this, most everyone, regardless of political leaning, would likely agree.

The trillion-dollar debate comes in how best to address at least some of the costly problems in our health care system.

Last week’s announcement that the U.S. Senate’s postponing the matter until after the August recess may well prove beneficial in the end. We’d urge federal legislators to take home with them a copy of the 1,000-page House bill and plenty of sticky notes.

The proposal demands close scrutiny of its many points. As always, following the money remains healthy advice.

Given that $2.5 trillion’s expected to be spent on health care this year, there’s a lot of money to follow. Reform doesn’t come cheaply, the nonpartisan Congressional Budget Office says. Its review of the U.S. House’s Affordable Health Choices Act says the plan would hike the federal deficit by an estimated $239 billion between 2010 and 2019.

The massive makeover also drops new layers of oversight into the health system. This comes during a time when states, local governments and the private sector are heading in the opposite direction — slashing expenses and jobs to make their books balance.

Among other things, the House legislation adds a new Health Choices Administration to the executive branch of federal government.

States aren’t ignored in this regard, either. Each state will have an Affordable Health Benefit Gateway, according to the Senate plan. They’ll be established either by states or the Beltway folks. They’re expected to “facilitate voluntary purchase of health insurance coverage ... at an affordable price.” The feds will provide kickoff financing, with the gateways expected to survive in the future by levying surcharges on insurance plans. That’s the carrot.

States not wanting to play along will see their residents made ineligible for insurance premium credits, expanded Medicaid matches or small business credits. That’s the stick.

The merits and efficacy of new bureaucratic layers should be debated seriously and weighed carefully against their cost.

There’s another hammer that the feds plan to wield to likewise compel individuals to sign up for a plan. Consider first that, in 2007, for whatever reason, 9.2 million people with household incomes of $75,000 and up lacked health insurance, according to the Committee for a Responsible Federal Budget.

Opting out won’t be an option in the eyes of Congress. “All individuals will be required to obtain health insurance coverage,” reads a Senate legislative summary. Be hard-headed about the matter and you’ll pay anyway — a minimum penalty of “no more than” $750 annually to “accomplish the goal of enhancing participation.” Thankfully, there are a few exceptions allowed from this mandate.

Universal participation’s key to making this all work, but compulsory insurance will prove a big pill for some Americans to swallow.

The reform measures are filled with profoundly new approaches covering everything from how “community health teams” help manage patient-centered care to the creation of a federal working group to share and implement ways to improve quality of care.

Increasing the number of insured Americans and reducing costly waste and inefficiency must be part of true health care reform.

It remains to be seen, though, how effectively the current plans attack these problems. Congress should use the coming recess to get a head start on figuring that out.

Andre Jackson, for the Editorial Board