House of Representatives passes health-reform bill

Finally some light at the end of the tunnel for Barack Obama. Only hours after I made my previous post, which for other reasons didn’t end up here sooner, America has made another step towards reforming its miserable health-care system. The House of Representatives passed a reform-bill, which will account for near- universal health-insurance. Some senators have still to make their own proposals, but if all works out the next step will be comparing the wishes of the House and the Senate. How and if they will be able to skip over the difficult bits is not yet clear, but things are at least moving.

Taking the events of the past months into account it is not altogether surprising that the government will have its share in the new policy. The way in which some aspects are put into writing reminds, at least in theory, of the Dutch system. First of all: Everyone must have health-insurance. The poorer- and middle incomes are eligible for subsidies however. The old system, leaning heavily on pillars such as Medicaid and Medicare, will fall apart, though Medicaid will be reintegrated into the new system. This form of integration also means expansion, since we know the numbers of uninsured are huge. The States will have to accept 15 million new applicants into Medicaid in an attempt to reduce this. Unlike in the Netherlands, where health-care is no free choice, the government will itself participate in the market as well (that is, if the bill is passed). Firms are appointed a share in the play too. Each company with a payroll larger than $500.000 will have to provide its workers with health-care. By my knowledge nothing is yet known on the level of the fines involved, but I dare say they will not make a balance sheet look brighter.

Not all is good however. We might first point to some issues that have been given their place in the bill as part of a compromise. Abortion-rights are neglected; apparently the freedom of choice does not go to such lengths as to allow surpassing old, religious doctrines or convictions. It was necessary however, because the bill would otherwise not have been able to get the support it needed in order to be passed. Another thing is the costs the new system will bring along. It will be cheaper than it is now. Families will see fees decline, which is a good thing. According to latest figures savings will amount to a maximum of $1260 a year (for a family of four). Less popular will be the costs for the public wallet. Estimates vary, but $1.05 trillion is the number mentioned by the Economist in its article “Claiming a Victory”, to be printed in this week’s edition (online release 9^th of November and to be found on http://economist.com , though for subscribers only). That is more than the maximum amount of 900 billion dollars Obama had been rhetorically preaching about earlier. I am delighted by the prospect that revenues will most likely be raised by taxing the rich, rather than middle-incomes this time round though.

Up to this even the more negative things are only minor blows. It could have been much worse.  Some things remain doubtful, for instance whether Medicaid will not waste huge amounts of money and whether government-run policies will actually be able to compete on the market without falling into the all too familiar traps. But, once again, nothing or in any case too less has been said and written about those things that actually tyrannize the American system: Bureaucracy, pay for services rather than quality, too less digitalization and too much wasting of medicines among other things. Whether cross-border competition will get going remains unclear, but we can hope the republicans will at least do some good by stressing the importance of that. Let’s also hope states will not be granted an option to opt-out, so that the system truly strives towards a distribution of this valuable good for all its society’s members.

And on the bright-side, things can hardly get any worse.  The system isn’t implemented yet of course, we don’t even know whether it will be, but the American citizens have at least gained some right again in hoping that this dauntingly long-term project will be tackled. Our attention can now be diverted towards the Senate.