Health care reform law is only half a loaf

Democrats have now cemented the idea of expanded health care insurance coverage in US politics. The GOP erred on that point. But both parties must now get medical-cost containment done right.

Americans can expect a host of political and legal challenges to the healthcare laws passed by the House in a historic vote on Sunday night. The mandate to buy insurance, the cuts to Medicare, the ban on funding for abortion, even the way the bills were passed – all may be subject to either change or outright reversal.

But on one point, the debate is likely over.

It will be hard for a future Congress, individual states, or the courts to roll back the idea that the basic desire for health is so universal that society must always look for new ways to help those seeking it.

The charitable impulse to restore the health of others has always been present in America. Few people with a health emergency, for example, are denied care at a hospital.

But as costs have risen with new technologies and treatments, the financial burden and the availability of care have became difficult issues. A shift was needed in responsibility for the costs.

Over the past half century, government has steadily taken over the task of providing care, first by aiding the poor and the elderly (Medicare, Medicaid, CHIPS). And now, when this new law’s benefits are expected to take effect in 2014, just about everyone can have health insurance.

That key point won, the debate over other issues remains, especially the government’s role in restraining medical inflation.

Republicans and some conservative Democrats were able to achieve some valuable successes in this debate.

The private-insurance system will likely not be overturned anytime soon, reinforcing the idea that market efficiencies are needed to restrain costs. States were able to retain a major role in healthcare regulation – Americans have more faith in local government than in Washington. And President Obama promises that he will help prevent this new entitlement from adding to the deficit over time.

The GOP, however, erred in not being forceful and united behind an alternative plan aimed at covering those in need. It chose to play power politics, hoping a united front against the Democrats’ plan will catapult the party to victory at the polls. While that may be true in coming elections, the party will nonetheless find it difficult to end the new federal role in ensuring access to health insurance.

The bill passed by Congress is expected to increase the percentage of Americans covered from 83 percent to perhaps 97 percent. Much of that increase will be in covering people forced to buy insurance – people who either don’t want it for personal reasons or would rather spend their money on other priorities. (Perhaps the law can be amended with a provision for coverage of spiritual care in order to prevent religious discrimination against those who rely on such means and don't use medical care.)

If the new law falters in restraining medical inflation, then an alternative plan using the GOP’s more market-based approach might be necessary. The percentage of Americans who are currently uninsured and who truly need government help is small enough that such a plan may work.

Because the new law is largely modeled after a healthcare law adopted by Massachusetts in 2006, it is instructive to see where that state is headed. Since the state law’s passage, people in Massachusetts have suffered the country’s largest increases in health insurance premiums – forcing Governor Deval Patrick to propose price controls on insurance firms. And this is a state with a high degree of competition within both the insurance and medical industries.

Forcibly capping premiums is a band-aid approach to resolving deeper issues in rising costs of medical care. Just as the GOP erred in not uniting behind a plan for expanded coverage, both Massachusetts and the Democrats in Congress erred in not first seeking solutions to medical inflation before expanding coverage.

In fact, one lesson from the victory of Republican Scott Brown in the January election to replace the late Sen. Edward Kennedy may not be the public’s revulsion to expanded healthcare. Rather the message for Democrats may be to first slow down the cost of healthcare.

Two votes – the Senate election in Massachusetts and now the House vote for expanding health insurance – have brought separate lessons for each party. Each vote made valuable points – one of fiscal restraint, the other of new ways for compassionate care.

Perhaps in the political and legal back-and-forth yet to come the two parties will find a way to work together and get healthcare done the right way.

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