U.S. Congress Passes Health Insurance Reform

Finally, 100 years after first being seriously proposed, the United States Congress has passed health insurance reforms which create a reasonably universal system. It does so in one of the most inefficient, complicated, and tepid ways possible, but the U.S. has lurched toward a more just society.

I have been fortunate to live in three different countries (soon to be four) over the course of my lifetime. The U.S. healthcare system is a disaster compared to the systems in these other countries, including Japan. In 2014, when most of the reforms kick in, the U.S. system will graduate to "so-so."

I am deeply disappointed that the U.S. Congress did not pass the so-called "public option." That is, most Americans under the age of 65 still will not have even the choice, at any price, of buying government-administered health insurance (such as Medicare) or healthcare (such as the Veterans Health Administration). I am also concerned because, without such a choice, the reforms could collapse. In particular, future Congresses (notably Republican) could tinker with subsidies and eligibility limits or worse. The reforms still need a lot of improvement.

However, there are still some relatively near-term and relatively realistic opportunities to improve these health insurance reforms. The most direct way is for Congress to pass Representative Alan Grayson's Medicare-for-all bill, HR 4789. It's a grand total of four pages, and it simply allows every American under 65 to buy into Medicare Part A at cost. Will the Democratic Party continue to be stupid about both politics and policy, or will they go into the November elections having passed this enormously popular significant improvement? I hope it's the latter.

Another way is if the Senate finally comes to its senses and amends the reconciliation bill to include a public option, preferably in the form of a Medicare expansion. (The Senate should also lift ERISA restrictions that prevent states from adopting single-payer plans should they choose.) Both changes would significantly reduce the deficit, so they are in order. Will Senator Bennet, facing a stiff primary challenge in Colorado, push to add the public option? I hope so.

Yet another way is, ironically, if Republican attorneys general succeed in scuttling the individual mandate in court. As law professor Erik Hall points out, their argument is a longshot at best. But if they do succeed, the quick fix is to mandate that individuals buy public health insurance (such as Medicare Part A) but allow a waiver if they already have qualified private insurance. So go on, Republican attorneys: fight that one as hard as you can.

I'm also disappointed that the U.S. continues to maintain a health insurance system connected to employment. That makes little sense. Working or not, everybody needs at least basic protection against the calamity of illness. And people who are not working cannot afford insurance premiums. (Will they instantly qualify for Medicaid when they lose their jobs, and without draining their accumulated assets? No, apparently not.) The degree of medical security offered to individuals with these reforms is limited.

But it's progress. More, please, and quickly.