When President Barack Obama‘s health care reform was making its way through Congress,Republicans and other opponents registered plenty of criticisms: It was too generous, too inflexible and too centralized. But such concerns were brushed aside in the push to get a bill passed.
Today, it’s harder to ignore those flaws. Implementation of the program has brought tougher challenges than the administration led Americans to expect. So it has been obliged to make some major concessions to reality.
Faced with companies that said they would drop "mini-med" policies whose benefits were deemed inadequate, the U.S. Department of Health and Human Services (HHS) granted hundreds of one-year waivers to ease the transition to more comprehensive coverage. The alternative was to leave millions of workers, who previously had some insurance protection, with none. Obama understandably didn’t want to wear the jacket for that outcome.
And when it became clear that a provision to furnish long-term care for the elderly would be too pricey to attract enough premium-paying applicants, the administration was wise enough not to try to propose new taxes to make up the difference. Instead, in deference to fiscal prudence and undeniable mathematics, it scrapped the undertaking.
Opponents have faulted the overall plan for a "one-size-fits-all approach" for the entire country. Apparently someone took heed. On Friday, HHS announced it is giving state governments a big say in the type of coverage offered within their borders. They would have a range of choices in deciding what to include as "essential benefits" in every policy.
It was presumptuous to think Washington should decree for every citizen what benefits are indispensable in a medical insurance policy. So the administration, again in retreat and conceding to reality, now will give states several options in deciding what has to be included.
Those options will be based on the offerings of certain small-group plans, state employee plans, federal employee plans and major health maintenance organizations (HMOs). A state could try to restrain the cost of the new federal program by selecting a relatively frugal package. But the flexibility would not be so great as to defeat the main purpose of the health care law, which is giving broader access to adequate insurance and care.
Liberal critics complained that some states will offer less than others. Maybe so, but they will be accountable to their own citizens for the difference. HHS Assistant Secretary Sherry Glied told The New York Times that the change "builds off the experience of today’s marketplace and will minimize disruption" — which is something to applaud.
This approach may be more an attempt to defuse Republican attacks in an election year than a frank admission that the administration was too rigid in its original approach. But it’s welcome regardless.
Still, it falls short of correcting all the flaws in the health care overhaul. As it stands, the program demands far too much in spending on preventive services that are unlikely to justify their cost.
It does little to restrain the long-term growth of spending on health care.
It doesn’t try to combat abuses of the malpractice system that impose needless costs on everyone.
It relies too much on ladling out new benefits and too little on insisting that the recipients pay for them.
The goal of the Obama health care plan is commendable: assuring medical insurance to millions who lack it and protecting it for those who have it. The changes the administration has made may be not enough to make it work optimally. But they’re a good start.