Posted on January 9, 2009

Commonwealth - analysis of health care bills


An Analysis of Leading Congressional Health Care Bills, 2007-2008

(Part I, Insurance Coverage)

By Sara R. Collins, Ph.D, Jennifer L. Nicholson, and Sheila D. Rustgi
The Commonwealth Fund
January 2009


This report analyzes and compares leading bills of the 110th Congress aimed at expanding and improving health insurance coverage. Bills and proposals from members of Congress and President-elect Barack Obama include plans to fundamentally reform the health insurance system through mixed private—public approaches that build on our current system; a public insurance option available to the entire population; bills to change the tax treatment of employer benefits; federal—state partnership to provide grants to states to expand coverage; and bills that would expand coverage for children or disabled individuals, among others. Using analysis from the Lewin Group, the authors provide coverage and cost estimates for the proposed bills, which range from 48.9 million uninsured people gaining coverage to a net loss of coverage for 283,000 people; proposals could increase national health spending by as much as $64.1 billion or create savings of $58.1 billion.

Executive Summary:

Full report (132 pages):


By Don McCanne, MD

For those who would like to have a better understanding of the various Congressional approaches to reform, this report is very helpful. The Lewin Group analysis brings reality to the claims being made by the proponents of each approach.

The proposals vary considerably in how effective they are (or are not) in expanding coverage to include everyone. Only one of the proposals evaluated, Representative Pete Stark’s AmeriCare Health Care Act, would be effective in covering everyone. The closest to this would be the Commonwealth (Obama/Baucus) and the Wyden proposals, but they would leave a few million without coverage.

Not only is Stark’s AmeriCare proposal the most effective in expanding coverage, it is also the least expensive in terms of our total National Health Expenditures, actually reducing spending by about $58 billion.

The results are no surprise. Many studies, such as the California Health Care Options Project (a study of nine models of reform) have shown that those models that build on our current system of private and public plans are the most expensive models of reform, and fall short on goals of universality, comprehensiveness, and equity. In contrast, the single payer model and health service model actually accomplish those goals while being the least expensive models of reform (though most Americans would prefer government health insurance to a government-owned health care delivery system).

To be clear, Pete Stark’s AmeriCare is not a single payer model. AmeriCare, an improved and expanded Medicare-like program, would cover 85 percent of us. The existing Medicare program would be improved and cover another 10 percent of us. Qualified employer-sponsored plans would cover 1 percent (yes, only one percent). Dual Eligible and TRICARE would cover the balance. Of the proposals studied, AmeriCare is the closest to single payer, though many single payer advocates would have preferred that Representative John Conyers’ HR 676 single payer bill be included in the analyses.

Perhaps it’s better that it wasn’t since it could have led to a misinterpretation and inevitable misuse of the findings. HR 676 would require that investor-owned providers be converted to not-for-profit status, and that the investors be compensated by public funds at the appraised value of the converted facilities. As only one example, the hospital corporation HCA has a book value of $24 billion. That alone would wipe out close to half of the savings of the Stark proposal.

The importance of this analysis is that, regardless of the politics, it’s the policies that count. Senator Mike Enzi, senior Republican on Senator Kennedy’s Health, Education, Labor and Pensions Committee, says that reform should include the 80 percent of policies on which we agree, and exclude the 20 percent on which we don’t, which is code language for rejecting policies that are not in his plan. His approach, heavily dependent on private plans, is the most expensive of all and yet leaves 22 million people uninsured. He has said, “Forcing private plans to compete with a public program like Medicare, with its price controls and ability to shift costs to private payers, will inevitably doom true competition and could ultimately lead to a single-payer, government-run health care program.”

People are going broke, suffering and even dying, and we continue with academic exercises on ideology-tinged policy options? It’s time to move on beyond the politics of ideology, and finally get into gear with the politics of sound policy. With a health care bill of well over $2 trillion, we need reform that works!