Illinois Republican Peter Roskam came right out and said that “the foundation for expansion is Medicaid” and that Medicaid is “flawed,” adding that “we can do much better.” He didn’t offer a substantive solution, however, other than starting over.
The president got the message when he asked the assembled whether there were any areas of agreement on coverage beyond what was in the bill sponsored by Ohio representative John Boehner—which calls for additional coverage for only three million people. Later Obama shot back that he did not get an answer. In his summation, the president admitted: “I don’t know frankly if we can close that gap.” In other words, there is still no consensus that everyone should have coverage. We still have not embraced the notion that in America health care is a right, rather than a privilege.
Same story with equity. Should everyone, young or old, be entitled to a minimum set of benefits? There was a lot of back and forth centering on a standardized set of benefits for policies offered in the Exchange, the proposed shopping service to help people select policies. Cantor couched standardized benefits in terms of fear of government. Does fear of government trump the security that minimum health benefits offer families? That, too, remains unresolved.
John McCain got at the equity issue in another way when he complained that 800,000 Medicare beneficiaries in Florida were protected against cuts in Medicare Advantage plans that could affect the benefits they receive or the amount they pay for them. McCain objected and framed the problem in terms of backroom politics: beneficiaries in Arizona, he said, couldn’t get the same deal. If he had negotiated such an arrangement for his people back home, what about equity for Florida beneficiaries? Equity in health care, it seems, depends on who is writing the rules rather than on some fundamental principle about equity in health care.
Regulation—how much and for whose benefit—was another biggie threaded throughout the summit. At this point, a goal of reform has become insurance regulation, and that came through loud and clear yesterday. It came up in the discussion of allowing carriers to sell policies across state lines—something companies would like to do. But the fear is carriers will license their policies in states with weak regulations and sell them in states with strong ones. Consumers in those states could lose those protections since the rules in weak states would prevail. Obama likened the problem to that of banks moving to states with high interest-rate limits for their credit cards, the phenomenon that has caused consumers so many headaches of late.
Regulation also came up in the context of the lengthy discussion of malpractice. Republicans generally want to limit the right of consumers harmed by medical errors to sue and cap the amount of damages they can recover. Democrats generally do not. In this case, the regulation seems to benefit doctors and hospitals.
The president indicated there might be some meeting of the minds on these two regulatory issues. But their outcome remains an unsettled matter as health reform moves to a new stage—another underreported takeaway from the summit.