Health care reform issues: Getting past the screaming

While the iconic images of this summer's health care debate have been the screaming matches at town hall meetings, experts maintain there is more substance to the argument than has so far been on display.

The raucous town halls, they said, reflected both a political effort to slow President Barack Obama's momentum as well as a general frustration about government intrusion into our personal lives.

"This isn't only about health care. . . . People are frustrated by the economy, unemployment, government bailouts for the banks and car companies - and they are venting," said Arthur Sanders, a politics professor at Drake University in Iowa. "There's been a very orchestrated effort to get people to yell at their congressman, but it's not representative of those who oppose health care reform."

Conservative analysts contend that many of the arguments made at these meetings - about death panels, socialism, doctors becoming government employees - are not the real reasons to fear Obama's plan. What people should be worried about, they said, is the potential cost of the program and its impact on the economy.

While Obama vows that the overhaul will not increase the federal deficit, analysts at conservative think tanks said there are reasons for concern:

 

Adding to the deficit

Obama's proposal would cost $900 billion over 10 years when Washington is already awash in red ink. The budget deficit during the same period is expected to total $9 trillion.

Some analysts question whether the country can afford a makeover of health care. The concerns center on the public option, a not-for-profit insurance plan to be offered along with private coverage in a new insurance exchange. People would pay premiums, as with private insurance, and physicians would receive higher reimbursements than under Medicare, but probably lower than those from private carriers.

Obama insists the public option will not be run or paid for by Washington. But conservatives are skeptical, saying a charity cannot sustain coverage in the long term.

"He wants to create a new entitlement when we know Medicare and Medicaid are in trouble," said Paul Howard, director of the Manhattan Institute's Center for Medical Progress. "Adding more spending is unsustainable. . . . We've got to get our fiscal house in order before we start building new wings."

 

Harm to private insurers

Conservatives said the public option also could drive private insurers out of business by undermining employer-based coverage, a point Obama disputes.

The argument is that prices for traditional plans would spike as young and healthy workers choose the cheaper public option, leaving the old and sick behind. The higher premiums also could compel some employers to drop group coverage in lieu of giving workers money to purchase insurance on their own.

"All you are doing is pushing people who were privately insured onto the government and taxpayers' burden," said Dr. Scott W. Atlas, senior fellow at the Hoover Institution.

In Maine and Hawaii, 60 percent to 80 percent of the people enrolled in public option plans had previously been covered by private insurers. The Hawaiian plan was rescinded after seven months because it strained the state treasury, he said.

 

Taxing the wrong group?

Other conservative analysts are dismayed by Obama's "timid" embrace of tax changes as a vehicle to insure more people and reduce costs.

Robert E. Moffit, director of the Heritage Foundation's Center for Health Policy Studies, decried the control government and employers have over insurance choices. If workers were given tax credits to purchase benefits, they would likely select less generous plans than they have now, he said.

States require insurers to cover about 2,000 treatments, some of which individuals probably would drop if given the choice. Also, residents of one state are barred from purchasing policies in another.

"A real reform of the system doesn't transfer more authority to Washington, but to families and individuals for decisions about health care," Moffit said. "If benefits were tax free, millions more would be insured and would be more cost-conscious in choosing coverage."

Howard agreed, adding that Obama was wrong to tax insurers, not policyholders, for gold-plated benefits. The move, together with the public option, insulates people from the benefits' true price tag.

Howard said, "You're cutting out a lot of experimentation in the market, including incentives to stay healthy. . . . Why should people act when they are isolated from any impact of premiums?"

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Opposing Obama’s plan

Conservatives agree with President Barack Obama’s diagnosis of what ails  the health care system  but oppose his remedy.

They say his proposals:

 

• Are too costly given the record federal budget deficit.

 

• Don’t adequately address the shortcomings of Medicare, Medicaid and other entitlements.

 

• Undermine private insurers by creating a government-run public-option plan.

 

• Have few incentives for policyholders to select cheaper coverage and to stay healthy.