Hullabaloo

Monday, September 14, 2009

 
Owning It

by dday

On 60 Minutes last night, the President vowed to take ownership of the health care legislation and its consequences.

Mr. Obama said he would take responsibility for any health-care legislation passed. "You know, I intend to be president for a while and once this bill passes, I own it," he said. "And if people look and say, 'You know what? This hasn't reduced my costs. My premiums are still going up 25%, insurance companies are still jerkin' me around,' I'm the one who's going to be held responsible."

But there are more possibilities than just increased costs and insurance company-created pain. There's a very real cost to women, many of whom will not be able to access legal medical services through their insurance plans.

HHS Secretary Kathleen Sebelius told me on ‘This Week’ the President will go beyond language in a House bill to make sure no public money goes to pay for abortions under health care reform.

Abortion foes argue language in the House bill has too many holes and that taxpayers could potentially subsidize abortions. Sebelius told me there will be no uncertainty with the President's plan.

“In fact recently the Catholic bishops came out, after the President’s statement saying that his statement about what he intends in the plan that no public fund would go to fund abortion and the fact that he has come out firmly for insuring all Americans and saying that it’s a moral issue as well as an economic issue and they endorsed moving forward. I think the legislative language will reflect what the President has just said.”

GEORGE: “So you are saying that he will go beyond what we have seen in the House and explicitly rule out any public funding for abortion?”

SEBELIUS: “Well that’s exactly what the President said and that’s what he intends that the bill he signs will do.”

The only way to go beyond the House bill is to restrict private insurers from offering reproductive services in any plans they offer in the insurance exchange. Which means that nobody in the individual market will have those legal medical services covered, in effect extending the Hyde Amendment ban from Medicaid to the entire individual insurance market. Meaning that health care "reform" would actually make it harder for millions of people to access reproductive choice services.

You see a similar dynamic with the arguments over the immigration provisions in the bill. The President was not wrong when he said any bill would not insure undocumented immigrants - he's just wrong to carry out such a spiteful, shortsighted threat.

Consider a few statistics. According to a July article in the American Journal of Public Health, immigrants typically arrive in America during their prime working years and tend to be younger and healthier than the rest of the U.S. population. As a result, health-care expenditures for the average immigrant are 55 percent lower than for a native-born American citizen with similar characteristics. With the ratio of seniors to workers projected to increase by 67 percent between 2010 and 2030, it stands to reason that including the relatively healthy, relatively employable and largely uninsured illegal population in some sort of universal health-care system would be a boon rather than a burden. "Insurance in principle has to cover the average medical cost of all the people it's serving," explains Leighton Ku, a professor of health policy at George Washington University. "So if you add cheaper people to the pool, like immigrants, you reduce the average cost." More undocumented workers, in other words, means lower premiums for everyone.

The actuarial advantages don't end there. As it is now, undocumented workers (and others) who can't pay their way receive free emergency and charitable care—a service that costs those of us with health insurance an additional $1,000 per year, as Obama noted. But if illegals were covered, this hidden tax would decrease, further lowering our premiums and "relieving some of the financial burden on state and local governments," says Harold Pollack, a University of Chicago professor who specializes in poverty and public health. What's more, employers currently have a clear economic incentive to hire undocumented immigrants: they don't require coverage. A plan that mandates insurance for native workers but not their illegal counterparts actually makes life harder on the blue-collar Americans competing for jobs (and railing against immigrants) because it means that hiring them will cost more than hiring a recent transplant from Mexico City. As The Washington Post's Ezra Klein recently explained, "If you're really worried about the native-born workforce, what you want to do is minimize the differences in labor costs between different types of workers. A health care policy that enlarges those differences—that makes documented workers more expensive compared to undocumented workers—is actually worse for the documented workers."

I'd add to this that blunt enforcement mechanisms like what is used in Medicaid cost millions of dollars for almost no material benefit, which even George Stephanopoulos was inclined to point out this weekend. Such systems also tend to weed out legal US citizens without proper documentation. And not letting immigrants participate in the exchanges with their own money, as was floated by the White House over the weekend, completely cuts them off from the individual market and further strains emergency rooms, who will be the doctors of last resort, making this whole spite-based policy grossly more expensive.

(By the way, when some legal resident gets denied coverage because of immigration enforcement provisions, I fully expect Republicans to be the first in line to usher him to a press conference as proof of how government doesn't work.)

Meanwhile, Amanda Marcotte notes that the entire wasteful enterprise to make sure that some alien other never ever gets one dime of the hardworking Murcan taxpayer money ever is a totally moot point:

Mexican migrants working in the United States may soon have their own affordable health insurance program. According to Mexico’s Health Department, it is launching a pilot program designed to encourage migrants who work in the states to sign up for the Mexican government’s Seguro Popular health insurance plan.

In 2003, Mexico set out to achieve universal health care, and from what I understand, they’re on track to reach their goal of doing so by 2012. They’ve done such a remarkable job because they have---you guessed it---a public option that everyone who has a job can buy into. (Except public sector workers, who are covered by a separate insurance system.) They also have a system of federally run clinics to administer to basic health care needs, regardless of employment status. It would be this public insurance that would reach out to migrant workers in the U.S. and encourage them to buy in. Of course, covering bills incurred by Mexican citizens who go to U.S. providers will be very expensive for Mexico, especially since they’ve kept internal health care costs so low. (About 1/3 of what the same procedures cost in the U.S.) Still, it’s both the humane and fair thing for Mexico to do, because migrant workers in the U.S. are good for the Mexican economy, putting billions of dollars into their economy every year. Unfortunately, the economic crisis in America has significantly reduced the average income levels of migrant workers in the U.S., which has impacted the remittance income tremendously. So the Mexican government is starting this pilot program even as immigration is making them less money.

Mexican health care is not an optimal model for the US, but the philosophy behind it is light years beyond what our brigade of idiots in Washington can fathom. Instead, we're jumping through hoops and implementing costly verification systems when Mexican workers can sign up for their home country's public option and never touch any American system to begin with.

If the President wants to "own" these stupid and petty political compromises which benefit his opponents but make no sense from the standpoint of economics or human decency, he'd better be prepared with some good arguments about them. From what I see, naked fear of Republican extremism is leading him to act against the interests of the public.


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dday 9/14/2009 03:00:00 PM |