Health-Care Bill After Compromise with Lieberman: Worse Than Nothing

The first rule of medicine is, "Do no harm." The post-Joe Lieberman version of the Senate health care bill fails that basic criterion. Unless Democratic leadership steps up to fix this misguided proposal, our only recourse will be to kill it.

The fundamental failing of the newest Senate proposal is that it requires individuals to purchase health insurance, but does nothing to rein in what insurance companies charge. There is nothing to stop spiraling health costs from eating up an ever-increasing percentage of our national productivity.

The House bill has two major cost-control mechanisms: the public option and the 85 percent medical-loss ratio requirement. The Senate bill is on track to have neither, and nothing new to replace them. The Senate bill is a recipe for national disaster. If it's that bill or nothing, I prefer nothing.

We all know America's current health care system is failing -- and it's failing everyone, not just the uninsured. It is far too expensive: Americans spend 16 percent  of GDP on health care and get worse results than countries that spend half that. Literally.

We need health reform that expands access to quality health care, abolishes unjust practices of insurers, improves value to the country, and puts us on a trajectory to continue to improve our health care system over time.

But the Senate has systematically stripped out nearly everything I liked about what was proposed in the early, heady days of health care reform. They have done so in order to please a handful of so-called centrists who care more about protecting corporate profits than protecting the people they claim to represent.

How do we judge whatever the Senate finally passes? How do we tell whether what's left of the bill is enough to support it?

There are four key questions we can use to evaluate the proposed reforms:

1. Affordable coverage for everyone: How close are we to the ideal that every American will have access to high-quality health care that they can afford?
2. Value: How much have we improved the value Americans get for our health care dollars -- so that we are healthier and get more for our money?
3. Fixing insurance company injustices: Have we reduced or eliminated the injustices caused by insurance companies when they destroy the lives of people who get sick by refusing to pay for care, or retroactively canceling their insurance?
4. Trajectory: Are we on a path towards continued improvements in all of those areas?

If we look at the current Senate proposal, the scorecard is not promising:

Affordable coverage for everyone: FAIL.

The latest CBO estimates for the Senate bill say that a family of four with a household income of $54,000/year should expect to pay 17% of their gross income on health care -- about $9,000/year. (And that was when there was a public option to hold down costs!) That's more than they'll spend on federal taxes. That's more than they'll spend on food. I'm guessing if you took a poll, very few Americans would consider that affordable. And because of the way they've approached this, there's no effective cost cap on premiums and nothing providing downward pressure, so this is a problem that would get worse rather than better over time.

Value: FAIL.

In January 2007, the McKinsey Global Institute released a study showing that the United States spends twice as much on health care as the rest of the industrialized world. It costs our economy an extra $480 billion per year -- roughly $1,600 for every man, woman and child in the country. It's not because we get more effective care: we have lower life expectancy and higher infant mortality. Our results are worse, even though we're spending twice as much.

We pay more because we've set up the system so that the incentives to insurance companies, doctors, hospitals, and patients are all messed up. We've set it up so that expensive ways to treat things are preferred to inexpensive ones, even when the inexpensive ones are better. We're not getting better care, just more expensive care. Insurance companies won't pay to let a diabetic see a podiatrist to keep their feet healthy, instead waiting to cover amputations. Why? Because maybe by the time an amputation is necessary, somebody else -- another insurance company or better yet Medicare -- will have to foot the bill. Voila! More expensive, worse care.