WASHINGTON, D.C.-The last time a Democratic White House tackled health-care reform on the massive scale now being talked about by President Barack Obama, the plan was dubbed "Clinton-care," and it was ultimately derailed by two people named Harry and Louise.
Starring in a series of commercials paid for by the health insurance lobbying group, the dejected-looking middle-class couple sat at their kitchen table worrying that government bureaucracy was about to intrude on their health coverage.
Flash-forward to today's debate: Democratic Sen. Sheldon Whitehouse of Rhode Island rose at a recent White House summit on health care and declared that the situation is too dire to allow that to happen again.
"This isn't a 'Harry and Louise' moment, it's a 'Thelma and Louise' moment," said Whitehouse, referring to the 1991 road trip movie featuring two women who band together while being pursed by the law. "We're in the car headed toward the cliff, and we must act."
But Obama seemed a little weary of such an analogy: "Now, I just want to be clear-if you actually saw the movie, they did drive over the cliff. That's not our intention here."
But conservatives are fearful that speeding health-care reform may already be hurtling America over the cliff-of greater governmental control under the guise of more choices. Obama's push for a government-run insurance option may decrease competition and lead to medical decisions being made in Washington instead of at kitchen tables across the nation.
Already with little debate and no congressional hearings, Obama was able to push through a $200 billion down payment on his health-care initiatives using the $787 billion stimulus package passed earlier this year: $65 billion to expand the federal health-care program for children of middle-class families making more than $60,000 a year; a $90 billion expansion of Medicaid; a $25 billion expansion of health-care subsidies for the unemployed; and a $20 billion investment on health technology research.
At the recent summit, an army of stakeholders representing doctors, insurance companies, businesses, unions, pharmaceutical companies, universities, and hospitals poured into the White House East Room at such a clip that White House aides had to keep bringing in more chairs. While disagreements are numerous, everyone seems to agree that something needs to be done. Health insurance premiums are growing at a rate four times faster than wages; in the last four years the average annual health premium for a family of four rose from $6,438 to $12,680. Nearly 46 million Americans are currently uninsured-and that number is expected to grow by 10 million during the next decade.
In broad terms the battle lines for fixing this are drawn between those who favor a market-based approach that fosters competition-building on the current employer-based insurance system that now insures 170 million-and those who envision an enlarged role for government. And the extreme version, a single-payer system, would make government the sole health insurance provider. Rep. John Conyers, D-Mich., has introduced legislation in previous congressional sessions to provide universal coverage by establishing the U.S. National Health Insurance Program. Sen. Ted Kennedy, D-Mass., has introduced legislation that would provide coverage by expanding the Medicare program to everyone.
During the presidential campaign, Obama proposed establishing a national public option plan as an alternative that would compete with existing private plans. Those opposed to a single-payer system worry that Obama's seemingly less radical reform still could further increase the role of government in health care and restrict the choices found in market-based coverage-in essence creating a de facto single-payer system through backdoor tactics-by creating an unlevel playing field where employers have incentive to dump their insured into the public plan, says Rep. Michael Burgess, a Texas Republican who is also a physician: "Obama said he doesn't want to take away the insurance you already have unless he prices the private market out of existence and then you have to take what he gives you."
Also worrisome are calls for a national health-care board, something Obama has titled the Institute for Comparative Effectiveness. In the stimulus package, $1.1 billion is set aside to lay the foundation for this institute that may start the government down the path of playing doctor with broad powers to determine what treatments work and are cost-effective. Richard Scott, a former health-care executive, has funneled about $5 million of his own money to run a $20 million ad campaign as part of his Conservatives for Patients' Rights effort-painting a picture of long lines at hospitals and personal decisions on care made by a national board. "When government gets involved, things go up, not down. I'm afraid we are going to have a FannieMed. We are going to do something where we end up hurting the people we are trying to help," he said.
Health professionals also worry about a proposal by Sen. Max Baucus, chairman of the Senate Finance Committee, to reduce the number of uninsured by expanding existing entitlement programs like Medicaid and allowing those 55 to 64 to join Medicare. Without these additional entitlement costs the Centers for Medicare and Medicaid Services estimates that Medicaid alone will grow nearly 8 percent annually during the next decade, hitting $673.7 billion in 2017.
What conservatives say they want to support are proposals that emphasize the power of markets and the ability of individuals to make their own decisions. Examples include:
• Greater Adoption of Health Savings Accounts. Created by Congress in 2003, these tax-free accounts allow individuals to pay lower premiums in exchange for higher deductibles. Money not used for premiums are placed in the savings account-in essence increasing that individual's medical rainy-day fund.
• Refundable tax credits. With small business unable to pay health insurance for employees, expanding these tax credits would provide greater incentives for small business owners to cover workers.
• Association Health Plans. Allowing groups of individuals or organizations to come together would create an economy of scale that could provide affordable group rates and erode the rolls of the uninsured.
Many at the White House health-care summit touted developments in Massachusetts, where a universal coverage law began in 2006. But Kevin Pho, a primary care physician from southern New Hampshire who runs a medical blog, says the state's health-care system has been bombarded with nearly half a million new patients: The wait time for a new patient to see a primary care doctor averaged 50 days, and those who can't wait often resort to emergency room visits-one of the costliest forms of health care. "It's a difficult pill to swallow," reasons Pho. "Health insurance without health-care access is basically useless."
Obama has already announced how he will pay for half of the estimated $1.2 trillion price tag for his health plans. And those specifics mean bad news for the nation's charitable organizations. The budget plan provides a $634 billion down payment for health-care reform with half of that money coming from tax increases for the wealthy. Specifically, Obama wants to reduce-from 35 percent to 28 percent-the deductions families making more than $250,000 can claim for charitable donations and other items.
"Charities are in demand whenever the economy is bad. We will be seeing more clients while being stretched for resources," worries Peggy Hartshorn, president of Heartbeat International, a nationwide network of more than a 1,000 nonprofit, faith-based pregnancy centers.
According to a study released this month by Bank of America and the Center on Philanthropy at Indiana University, 47 percent responding said they would give less if deductions were wiped out, with 10 percent predicting that their gifts would dramatically decrease. Reduced incentive to give could end up ripping a hole in the safety net provided by such charities. Hartshorn doesn't miss the irony in taking from charities to pay for an expanded government role in health care: "Obama is showing no faith at all in faith-based organizations."