GUESTWORK | Janet Trautwein President Obama recently convened lawmakers from both parties at the White House for a summit on health reform. Although the attendees failed to strike a grand compromise, Democratic congressional leaders still have time to incorporate some Republican ideas in order to produce a final bill that’s genuinely bipartisan.
Such bipartisanship would be politically astute, thanks to the disappearance of the Democrats’ supermajority in the Senate. But it would also be good policy, as several ideas for improving the reform package, like strengthening the individual mandate and redoubling efforts to control health costs, could attract support from both parties. Lawmakers should ensure that these fixes are at the center of the final legislation.
Two broad principles formed the core of the original reform package and should remain at the center of a new bipartisan measure. First, insurers should not be allowed to reject applicants with pre-existing conditions. And second, all Americans must maintain insurance coverage.
Both principles are critical to the success of reform. If coverage is guaranteed irrespective of a patient’s health status or medical history, it’s in the patient’s interest to avoid purchasing a policy until he’s sick and needs it.
That’s where the mandate comes in. It prevents people from gaming the system and ensures that insurance prices won’t spiral out of control. After all, if there’s no penalty for going without insurance, then the risk pool will be comprised entirely of older, less healthy patients who need the coverage — and whose care is extremely costly. Insurers would have to compensate by raising premiums, until coverage was unaffordable.
The initial reform package failed to address this problem. The Senate bill, for instance, would only fine people who choose to go without insurance $95. Eventually, that fine would increase to $750. But by then, the average individual insurance plan is expected to cost $5,000.
For most healthy people, it would be far cheaper to simply pay the fine and pick up a policy down the road. Without a stronger individual mandate, universal coverage will be impossible to achieve — and health costs will continue to increase apace.
A renewed push for health care reform should also devote more attention to checking the rapid growth of health costs. One effective cost-control initiative supported by lawmakers from both parties is medical malpractice reform.
Many doctors fear the prospect of a debilitating medical-liability lawsuit — and understandably so. Roughly one in seven doctors faces such a suit each year. In order
continued on page 6