The Government and Health Care: What's Next?

Where is it all going? What can we expect? This article breaks it down into three areas of consideration; Costs, Mandates, and a Public Plan:

Health care: Deal or no deal? Senators begin work

[...] Sen. Ron Wyden, D-Ore., sees opportunity. "There is a very appealing philosophical truce within the Senate's grasp," he said.

"Democrats are right on the idea that we've got to cover everybody. Republicans have been right on the role of the private sector, not freezing innovation and staying away from price controls," Wyden said. "You meld those philosophical views and you are on your way to 68 to 70 votes."

Consensus is growing on many points: Changes should build on the current system, not scrap it; hospitals and doctors should be paid for quality, not quantity; insurers shouldn't be able to discriminate against people with health problems; small businesses need special attention.

But huge differences remain. Three of the hardest issues are:

Costs:

Obama set aside $634 billion in his budget as a "down payment" for health care over 10 years. Many experts believe that represents less than half the cost. Covering the uninsured could cost $100 billion to $150 billion a year, or more.

Liberal Democrats want to follow Obama's example and get half the money from tax increases and half from spending cuts. Upper-income tax increases and sales tax increases on alcoholic beverages, tobacco products and even sugary sodas are being discussed.

But Republicans and fiscally conservative Democrats want most of the financing to come from spending cuts and from making the health care system less wasteful.

Mandates:

Health insurance is based on pooling risk: premiums from the vast majority of healthy people cover care for the sick. For the system to work, economists say, everyone should have health insurance from the outset so uninsured people don't end up going to the emergency room and driving up costs for everyone else.

Because insurance is expensive, requiring people and businesses to pay for it is politically difficult. Most people now get insurance from their employers, but companies aren't required to offer it and as the economy skids more have cut back.

Obama and Democrats are considering a combination of requirements on individuals, parents and employers, with exemptions for small businesses and sliding-scale subsidies for families making as much as $80,000 a year.

Republicans opposed an employer mandate in the 1990s, but have mixed views on an individual requirement. The insurance industry is supporting an individual mandate. Labor unions are pushing for employer mandates.

Public Plan:

Obama and the Democrats want to give middle-class workers and families the option of joining a government-sponsored insurance plan that would be offered alongside private ones through a new insurance clearinghouse.

Supporters say a public plan could be a testing ground for innovations and a check on private insurers. Republicans see it as a thinly disguised step toward a government-run system. Insurance companies say they wouldn't be able to compete with a government plan.

Efforts are under way to find a compromise, maybe by limiting the scope of the public plan. But Rep. Dave Camp, who is playing a leading role in the House, said he doesn't think a deal is possible. "The public plan is a bright line for us," said Camp, R-Mich. [...]

And so the tug-of-war begins. Who knows what we will end up with. At any rate, we SHALL see.