We heard this week from a friend of the Op-Ed page, Carolyn Keenan Kmiec, the wife of Douglas Kmiec. Both are on leave from Pepperdine University while Doug is serving as U.S. ambassador to the Republic of Malta. As strong supporters of President Obama's efforts to have healthcare understood as a basic human right, they are constantly being asked why the U.S. lacks the universal coverage that exists even in a far less affluent nation like Malta. This is an especially awkward question, noted Carol, "when one considers that Maltese doctors view house calls -- in this age of obesity and poor nutritional habits -- as vital to the doctor-patient relationship."
The Kmiecs sat down at the dinner table with their adult children to ascertain exactly what they all understood about the current debate. It rather quickly became apparent that they had more questions than "genuinely objective" answers, and they doubted they were alone.
We submitted the Kmiec family questions, which the ambassador stressed reflect only his personal views, to Jon Healey, The Times' editorial board specialist on healthcare reform, in an attempt to arrive at those "genuinely objective" answers. Healey culled the answers mainly from the text of the Senate-passed bill, HR 3590, and the proposed reconciliation bill, HR 4872. He also relied on the summaries provided by the House Rules Committee on Thursday and Obama last month, as well as an analysis by the Kaiser Family Foundation
The Kmiecs' 20 questions and Healey's answers follow.
Does the reform -- actually or effectively -- amount to the direct provision of healthcare by the government?
The government is a direct provider of healthcare only for military personnel and veterans, and the bill would not change that. The government's role as a provider of health insurance would increase, however, as Medicaid would be extended to more low-income adults and new subsidies would be offered to help make private insurance affordable to those earning less than four times the federal poverty level (currently, about $22,000 for a family of four).
The legislation also would significantly increase the federal government's role as a healthcare regulator. It would require Americans to obtain health insurance coverage and set minimum standards for what individual policies covered.
Who will be the principal beneficiaries? Specifically, of those without insurance now, who will be receiving it under the reform? Who will still be left out?
The that of the 54 million people likely to be uninsured in 2019, about 32 million would be covered as a result of the legislation. Included are low-income adults who couldn't afford coverage without the help of taxpayer subsidies, individuals with chronic diseases or preexisting conditions whom insurers would otherwise deny coverage, and healthy people who might otherwise decide not to carry insurance. Left out would be workers who cannot afford coverage even with the subsidies, those who decide to pay the tax penalty in lieu of carrying insurance and illegal immigrants.
It would be a mistake, however, to overlook the benefits the legislation could bring to those who are already insured. Much of the measure is devoted to changing the incentives in the reimbursement system for healthcare to promote efficiency and quality -- in other words, to reorient the system toward keeping people well, rather than profiting from their ailments. The result should be slower growth in healthcare costsover time, which would be a boon to the economy.The bill makes no guarantees on that front, however, and there are no sure ways to limit the demand that drives healthcare spending ever higher.
How does the proposed reform affect Medicare?