The Very Conservative House Democrats' Health Care Reform

While the health care reform bill released by the House Democrats will be to the left of whatever bill comes out of the Senate Finance Committee, it is important to note just how very conservative the bill is. It more a set of patches fixing the worst problems in our health care system than it is true reform.

The House bill is neither transformational change, radical reform, or a system wide overhaul. It is not “socialized medicine” (VA health system for all), universal single-payer (Medicare for all), a Medicare buy-in open to all, or even a complete individual self-selecting exchange system (Federal Employees Health Benefits Plan for all).

It is more notable for what the bill does not change than what it does. It does not change how insurance is paid for, who pays for it, or where most Americans get it from. The vast majority of Americans will only experience minor change.

Americans currently getting insurance from a federal program like Medicare, Medicaid, VA, and Tricare will continue to receive basically the same insurance. The majority of Americans who get employer provided insurance will receive the same or similar insurance from their company. The main change they will see is no longer fearing coverage denied for a pre-existing condition and perhaps a small reduction in co-pay for preventative care. Health insurance for the millions on a current federal program will be paid for with the same taxes as always, and the exclusion for employer-provided health insurance will remain unchanged.

Only the small percentage of Americans currently uninsured, self-insured, and employees at very small businesses will see a lot of change in their health care (at least for the first decade).

The poorest from that group will be given Medicaid, and the rest will get federal assistance in the form of credits to small businesses and subsidies for individuals to purchase an insurance plan offered on the new regulated market place. The new public plan which is supposed to provide “competition and keep insurance companies honest” will only compete for the roughly 8% of Americans who can get coverage through the exchange.

The bill does fix most of our health care system's worst problems. New regulation will hopefully stop the most morally reprehensible private insurance practices. The Medicare Part D “doughnut hole” problem will be improve, and a new Medicare payment structure should hopefully arrest the increase in cost. People who currently fall through the coverage cracks will get help buying decent health insurance which will be expensive but not crushingly burdensome.

The House bill does not transform our health care system, instead it patches most of the problems with our current confusing quilt of coverage. It is inherently very conservative because it tries to fix our current system, not replace it.