June 23, 2018
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Health debate options

As important as the details of the health care legislation negotiated by Senate Democrats is the fact that the overhaul debate continues. The compromise — which includes provisions to allow younger Americans to buy into Medicare and to have the federal personnel office negotiate insurance deals for average Americans as it now does for federal employees — is far from a finished product, but it shows a willingness to keep searching for a needed solution.

Sen. Majority Leader Harry Reid may be too eager to rush through a bill before the end of the year, but at the same time, the rapidly rising cost of health insurance is causing people to forgo medical treatment and to bear enormous debt when they do get care. They shouldn’t have to wait much longer for relief. Nor should businesses that are devoting larger and larger shares of their limited resources toward health insurance. This keeps companies from hiring new people and investing in innovation. Allowing this to continue, especially in this economic climate, is bad business.

The major problem that this week’s compromise seeks to avoid is the controversial public option. Republicans have made it clear that they will not support a bill that includes a government-run insurance option that competes with private companies. To get around this, without losing the support of liberal Democrats who support the public option, a group of 10 Senate Democrats proposed that people between the ages of 55 and 64 be allowed to buy into Medicare and that the Office of Personnel Management would negotiate plans, to be run by private insurers, that could be purchased by those without insurance.

Both have attractive aspects, but leave many questions unanswered.

For example, bringing younger and presumably healthier people into Medicare would broaden the pool of people included in the government program. This would spread the cost of expensive treatments over a larger group of people, which is the whole idea behind insurance. But given Medicare’s already shaky financial footing, it is unclear whether an expansion would make the program more stable. Hospitals and other medical providers worry that Medicare reimbursement rates are already too low, although it is unclear how much medical procedures at most facilities actually cost versus what the facilities charge for them. This highlights the need for transparency.

Having the federal personnel office, which manages the federal employee benefits program (including coverage for members of Congress), negotiate private insurance plans is intriguing. It could be a more effective way to ensure competition among insurance companies than a public option because of the large volume of customers that insurers would compete for. A more direct approach, says Sen. Olympia Snowe, is to allow the public to buy into the plans currently available to federal employees rather than negotiating new ones.

The true test of reform legislation is whether it will extend insurance coverage to more people while lowering costs. It is far from clear whether this proposal meets that test. But it is encouraging that many lawmakers are continuing to look for ways to meet these goals. That is where the focus should remain as the health care debate continues.

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