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Borde-nough: Democrats: What will you tell your constituents?

Published: March 26, 2010
Section: Opinions


Imagine that you’re a Democratic member of Congress who voted for the recent health care legislation backed by President Barack Obama.

You’re at home in your district telling your constituents about all your hard work. How will you respond when they bring up the new health care law?

Thank you so much for universal health care. You’ll smile, pat this person on the back, and say, “That’s what you sent me to Washington to do.” Then you’ll change the subject, because you know that an estimated 23 million Americans will still lack coverage in ten years under the new law.

Bypassing the Senate filibuster rule was the right thing to do. “Definitely,” you’ll say. But privately, you’ll wonder. If you live by the sword, you just might die by it, too. When Republicans control the White House and Congress again, what will Democrats do then?

Comparisons of Obama’s efforts in connection with the new law with efforts of earlier presidents’ efforts to pass legislation are not apt. Other presidents worked within the rules rather than discarding them. Bypassing the filibuster will someday look less like genius and more like a short-sighted effort to gain electoral advantage.

You didn’t have to do any dirty deals to get this passed, right? “No,” you’ll say reassuringly, and you’ll be right, in a sense. It was Obama who made the deals.

In exchange for financing an advertising campaign for the president’s health bill, the health care industry got to draft large parts of it.

They created their dream scenario. Their revenue streams will flow from the seemingly bottomless Federal purse even in hard times. And Americans who aren’t their customers will be penalized, creating a captive market.

I’ve got a job but no insurance. Thanks for hooking me up! You’ll say, “You’re welcome,” but your heart won’t be in it. Most people won’t get anything for years. Only people making less than four times the Federal Poverty Level (roughly $44,000 for an individual and $88,000 for a family of four) will qualify for any subsidy at all.

Furthermore, the subsidies won’t buy a policy. Their insurance-buying value will fall over time, because the FPL is indexed to the ordinary rather than the higher medical rate of inflation. Even people with big subsidies will have to pay between three and four percent of their income to insurance companies; for those with smaller subsidies, the figure is closer to ten percent.

Hype surrounded the prospect of requiring employers to insure their employees. But many employers will find it cheaper to pay a tax penalty. Some may fire employees rather than cover them.

How’d you manage to do this and still reduce the deficit? “We’re smart,” you’ll say. But the numbers are estimates. The Congressional Budget Office called the law’s “budgetary impact … very uncertain.”

The numbers are based on the law never being amended. Amendments will surely be made to account for inflation. Subsidies are not indexed to the rate of medical inflation.

Moreover, the CBO’s estimate about the law’s effect on the deficit is based on the assumption, among others, “that Medicare spending would increase significantly more slowly during the next two decades than it has increased during the past two decades.”

How likely is that?

The law includes certain cuts in payments to health care providers and hospitals that serve disproportionate numbers of people without sufficient insurance. The cuts helped make the new law look cost-effective, but more money will likely have to be allocated in the future to maintain service.

Finally, uninsured people who had relied on the government to pay for emergency room visits must now buy insurance. The government’s whole burden of providing care to these people was shifted onto their backs; subsidies will help them with only part of it.

I’ve got health insurance from my employer, and I don’t fall into any groups whose taxes are going up. I don’t have anything to worry about, right? You’ll say “Right,” shake this person’s hand, and quickly walk away. This person will face waiting lines—or longer waiting lines—as the newly insured crowd into health care providers’ offices.

Worst of all, the quality of this person’s (and others’) insurance is likely to fall. The new law allows plans, including those offered by employers, to set high deductibles and to cover as little as 60 percent of the costs of benefits.

Insurance that covers so little isn’t of much help when benefits cost thousands, tens of thousands, or even hundreds of thousands of dollars. Insured workers will find themselves under bargaining pressure from employers eager to reduce benefits to this cheaper but inadequate level.

In the end, you’ll be able to answer all the questions but one: “How am I going to get reelected?”