January 17, 2018
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A Necessary Prescription

President Barack Obama had the difficult task Wednesday night of convincing a skeptical public and divided Congress that not only was health care reform necessary — now — but that a plan like he outlined was the best way to proceed. The true measure of the success of his prime-time speech isn’t what the pundits had to say afterward (liberal commentators loved it, conservative ones found lots of faults) but what Congress does in coming weeks.

As the president said, inaction or delay is unacceptable. “Everyone in this room knows what will happen if we do nothing,” he said near the end of his address. “Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result.”

President Obama reiterated the failings of our current system: We spend 1½ times as much per person as any other country and Americans aren’t any healthier. We are the only advanced country that doesn’t ensure all of its citizens are covered by health insurance. We are the only country where families go bankrupt because of medical bills. Rising insurance costs make U.S. businesses less competitive and stifle innovation by keeping would-be entrepreneurs in jobs with health insurance.

While the reasons for reform should be clear, the solution has not been, in part because the debate has been hijacked by talk of “death panels” and “government-run health care.” President Obama, perhaps not as succinctly as possible, outlined his solution, which would meet three goals. It would provide more “security and stability” to those with insurance; extend insurance to those without it; and slow the growth of health care costs.

Stability and security would come from needed restrictions on insurance companies, such as barring denials of coverage because of pre-existing conditions or dropping coverage when someone becomes sick or injured.

The biggest change is that individuals would be mandated to have health insurance, and employers, but not most small businesses, would be required to provide insurance or help cover the cost of insurance for their workers. For those without insurance, an exchange would be created where individuals and small businesses could buy insurance. A public option would be available to ensure competition.

The president was vague about reducing costs, but suggested an emphasis on cost-effective best practices and reducing waste and inefficiency in Medicare and Medicaid. He also pledged immediate authorization of projects to test malpractice reform, an element Republicans have long said should be part of the plan although 33 states already cap malpractice awards.

Max Baucus, the Montana Democrat who chairs the Senate Finance Committee, said the president’s proposal was “uncannily similar” to what his committee is working on. Theirs is the only group still drafting legislation and the only one where Republicans continue to participate.

Commentators only half-joked that the president should give his speech in Maine. Sen. Olympia Snowe, a member of the Finance Committee and its Gang of Six that is negotiating legislation, is considered the most likely Republican to back sweeping reform.

Negotiations and compromises are necessary; delay and inaction are unacceptable. Success depends on the willingness of key players, Sen. Snowe among them, to meet the urgency of the problem with leadership and courage.

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