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The Tampa Tribune

Published: October 18, 2009

The debate about the health care system's overhaul is filled with topics and terms unfamiliar to many. Each week, we'll examine some of the issues, the politics behind them and how they would affect consumers.

PREMIUM COST GENERATION GAP

Should older Americans have to pay higher insurance premiums than younger Americans?

THE POLITICS: The double-edged sword of the health care debate is the age gap in insurance premiums. Americans between 50 and 65 who purchase their own insurance typically pay much higher premiums than younger people. Once they turn 65, Medicare takes over insurance coverage and the premium difference is no longer an issue. Workers who get their insurance through large employers, as a rule do not face that premium gap. But for those who buy their own, the difference in price can be six or seven times higher for older workers than it is for the younger generation. The Obama administration and Democratic lawmakers want to reduce the premium price difference, as a handful of states already do.

WHAT IT MEANS: The simple business decision by insurance companies is clear: Older Americans typically need more health care. Requiring that premium prices be less disparate means younger people would have to pay higher premiums to make up for the loss of insurance company revenue. The insurance industry says a mandate to keep the difference in premium costs between older and younger workers at no more than 2-to-1 would drive premium prices up for those younger workers by as much as 59 percent. Pending legislation in the House and Senate would include tax credits - or subsidies - for low- and middle-income Americans to help keep premium costs at or below 12.5 percent of an individual's income. That could help many young people, as could one Senate proposal that requires that all policies provide dependent coverage for sons and daughters up to the age of 26.

END-OF-LIFE DECISIONS

Would proposed health care legislation pay for counseling that might encourage elderly people to end their lives sooner than they might otherwise do?

THE POLITICS: This became one of the summer's most explosive topics, with flatly untrue claims competing with mere exaggerations and often-confusing explanations.

Pending House legislation would let Medicare reimburse doctors who consult with patients on end-of-life care. Patients could discuss the degree to which they want extensive steps taken to keep them alive as they grow increasingly ill or incapacitated.

They might draw up advance directives, powers of attorney and "do not resuscitate" orders to express their wishes or authorize someone to make decisions.

Proponents say many welcome such voluntary discussions, and Medicare should pay for them. Critics say government-paid consultations could encourage people to accept death rather than opt for costly medical procedures that could extend their lives.

Some contend that "death panels" would promote euthanasia. Proponents of the bill, including authors of the provision, call the claims absurd and reckless.

WHAT IT MEANS: The furor became so intense that Obama administration officials have signaled the proposed Medicare benefit will be dropped.

It's unclear what political lessons might be drawn. Did conservative activists inspire their base by showing that loud, emotional protests can force President Barack Obama and other Democrats to back down? Or did they spend a tremendous amount of energy on a fairly minor proposal that will be tossed aside while Congress enacts changes that conservatives oppose?

A SINGLE-PAYER SYSTEM?

Should there be a government-run, single-payer national health care system?

THE POLITICS: A government-run health care system is attractive to many Democrats, who want access to health insurance for all, including about 45 million uninsured Americans.

One proposal in Congress would establish a program to provide free health care to everyone in the United States through a publicly financed but privately delivered system. It would be paid for by raising taxes on the top 5 percent of income earners; instituting a progressive excise tax on payroll and self-employment income; and taxing stock and bond transactions.

A doctors' group, Physicians for a National Health Program, says streamlining payment through a single nonprofit payer would save more than $400 billion a year - enough to provide coverage for all Americans. Republicans oppose the single-payer approach, like those in Canada and many European countries, warning it would lead to a system where choice of care, treatments and a patient's doctor would be mandated by Washington bureaucrats.

They say a government takeover would curtail new treatments, drugs and innovation.

WHAT IT MEANS: The idea of a single-payer system doesn't have much traction. President Barack Obama has distanced himself from the idea, saying it works well in some countries but wouldn't be practical in the United States because so many people get private insurance through their employers.

The Associated Press

The debate about the health care system's overhaul is filled with topics and terms unfamiliar to many. Each week, we'll examine some of the issues, the politics behind them and how they would affect consumers.

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