The healthcare reform, increased coverage for more people, that has taken place divided Congress as absolutely as it possibly could. Part of the problem was that President Obama took an approach of hands-off at the initial stages. To make a major non-incremental change requires major funding, leadership by the President, positive publicity and a public behind the idea rallied by the President. Non-incremental reform is rare because it much different than making other policies. Certainly, Presidents do take the lead in pushing for policy changes, but non-incremental policy making requires that not only does the President rally Congress but the public as well and have the money for the project. President Obama's biggest mistake was to leave it to Congress to develop the details of healthcare reform. By doing so he lost the ability to make any major change.
Now it is true that many perceive what has taken place as a major change, one that means that government intrudes into an area that they have not before. This view has to do with another idea related to policymaking. That is distributive and redistributive, a couple of fancy words. Simply put distributive policies are those that have large consensus behind them and are perceived to help the general public. The bureaucracy, that is federal employees, specific Congressional subcommittees, and regular lobbying groups establish policy on and on-going basis. The classic is agricultural supports for various crops. They do not rise to a battle. Redistributive policies are policies that are perceived to take from one group and give to another, the classic is welfare policies. The president may get involved, opposing interest groups rather than simply supportive interest groups, and many members of Congress. Many of these policies get nowhere or only minor changes occur, because Congress cannot agree.
Incremental policy change is exactly what happened with healthcare reform. It was contentious and in the ultimate of divisions, all Senate Republicans disagreed with all Democrats and few Republican house members crossed party lines. And in a reversal of roles, the AMA, the hospital associations and other well-known health service associations supported reform and were opposed by new temporary interest groups forming to oppose healthcare reform along with the insurance industry.
Its incremental because the new healthcare reform did not lead the federal government into intruding into healthcare for the first time. We have a huge veteran's healthcare system (something I would argue should be eliminated in favor of veterans going to private and nonprofit hospitals that are much more readily available.) Medicare regulation is highly intrusive. It sets the standards of reimbursement that other insurance companies generally follow. It requires hospitals to calculate costs in a certain way, a very intrusive mechanism. Second, as most people know, most of us will obtain our health insurance from employers, not from the federal government.
It does require citizens to pay a tax if they choose not to be covered, perhaps the most damming and radical aspect of the healthcare reform. I do not wish to downplay this aspect.
But let us return to other aspects that are incremental. The reform will fix the doughnut hole in Medicare Part D, prescription coverage. Right now once seniors have used their prescription coverage up to a certain $ amount, they must begin paying on their own. After they pay a certain amount, then their Medicare coverage will again pay. It is good fix to end this donut hole but has nothing to do with mass coverage of the population.
It sets up a series of experiments to contain costs and has no new cost controls. And of course, one of the reasons for having health care reform was to reduce costs. It also allows parents to keep their children on their policies for a longer period of time. This expands the pool of citizens covered without costing much since college age kids are one of the healthiest groups to cover. It does nothing about the costs of illegal alien healthcare. The legislation states that illegal aliens are not covered, but indirectly they are. That is because hospitals cannot refuse to accept a patient in need. They can transfer a patient who has no insurance one stabilized. What this means is that you and I as taxpayers must support their care through our city and county public hospitals. And so, the new healthcare reform, as vitriolic as the debate was is largely a piece of incremental legislation that will be tweaked in the years to come.
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