Health care reform at our expense

Americans, it appears, will have health care reform whether we want it or not. And most of us don't want it, polls show. That doesn't seem to matter to Congress, which in a frenzy of deal-making came up with a near-incomprehensible mess of proposed changes to a health-care system that serves most people well.

What the ultimate "reform" actually does will depend on how the Democrats in Congress merge the House and Senate bills in the coming weeks.

We know this: The bills have virtually no Republican support, and the Democrats have lost a large number of independent voters who have bolted from the president they helped elect. What began as a promising push for bipartisan change, morphed into the usual backroom deals.

And the Democratic leadership took advantage of its power to ram through bills that leave many Americans, the great majority of whom have health care coverage, wondering whether they will be able to keep that coverage and how much it is going to cost them.

The Democrats calculated it was to their political advantage to get something passed. But the cost of adding some 31 million Americans to the ranks of the insured will be borne by others. And the added burden to an already strained system could diminish care for all.

Most people understand reform is necessary to control the ever-spiraling costs. And there also has been general agreement that more people in this wealthy nation should have insurance and access to health care, including those with pre-existing conditions. The fight was always how to do it.

The election of President Barack Obama promised an overhaul of the entire health care sector and greater government control of the process. And that is what we're about to get. The tentacles of the new law will stretch far beyond where government has ventured before.

The two bills, more than 4,000 pages in total, are a mishmash. There are no guarantees that those who like their insurance today will be able to keep it. Nor are most Americans persuaded they won't be paying higher taxes for the new entitlement, despite the president's assurances.

In writing the legislation, politicians lost interest in trying to lower costs and focused instead on increasing coverage. We'll start paying for that new coverage next year, even though it won't go into effect until after the 2012 election.

We understand the idea behind getting more people insured. They would have access to preventive care. The newly insured wouldn't have to depend on emergency rooms any more or wait until they are so sick the cost of treatment becomes exponential.

But there aren't enough primary care physicians to provide preventive care to all those people, and there's no guarantee the newly insured would make those well-care visits. Still, the argument goes, if they get sick, they'll have coverage through either private insurance through their employers or private exchanges, Medicare or Medicaid.

And someone must pay for it.

Preventive care may help contain costs somewhat - though there is doubt about that - but it won't pay for coverage. That will come under both bills through raising taxes and cutting Medicare and Medicaid reimbursements. While there is surely "waste" in the system, extensive cuts could limit both physicians' participation and patients' care.

Obama says the plan would reduce the federal budget deficit by more than $1 trillion over the next 20 years, even though by some estimates, health care reform will cost the American people $2.5 trillion in the first 10 years. It's hard to get your head around those numbers.

So how are we going to pay for it?

While the House bill would tax the wealthy - 5.4 percent on individuals making more than $500,000 a year and $1 million for families - the Senate bill hits people who buy more expensive health care coverage.

The Senate would impose a 40 percent excise tax on high-cost health plans, those so-called "Cadillac plans" that cost more than $8,500 a year for an individual and $23,000 for a family. This would include plans offered to federal employees. There is also a federal premium tax on insurers. That tax will, of course, be passed on to consumers.

Howard Dean, the former Vermont governor and head of the Democratic National Committee, pointed out last week that both plans allow insurance companies to charge different amounts based on the age of the patient. That makes sense from a cost-containment perspective because as patients get older, they generally need more care.

But, says Dean, such a rule would make insurance unaffordable to a lot of people. "Suppose you make $70,000, $80,000 a year;" Dean said. "You could end up paying $20,000 for your insurance under the Senate bill."

The Senate bill passed Christmas Eve only because Majority Leader Harry Reid made extraordinary promises to wavering senators. And now Congress is prepared to spend our money as if it is theirs to hand out to whomever they choose. Public option or private exchanges, the new system moves us closer to nationalized health care.