Passing Laws Vs. Solving Problems

It's hard to recall a vote in the House of Representatives which has been as closely watched or widely discussed and debated as Sunday's vote on health insurance reform legislation.

But it's not hard to be a little concerned that the legislation once again will highlight the confusion Members of Congress and the Administration regularly experience on big issues: the notion that passing a law is the same as solving a problem.

Because from where I sit here in the grass roots of America, the problems with implementation of this new law (assuming it passes in the Senate and is actually permitted to take effect) are just beginning...and they're huge.

I take very little issue with the intentions of the bill: especially in the face of our current economic downturn, with high unemployment and great uncertainty about the future, literally millions of families are seeing their health security...if they ever had it..evaporate. And the market for individual health coverage (created by the enactment of HIPAA in the mid-1990's, by a Republican Congress) had plenty of built-in dysfunction which fairly cried out for regulation. Generally, premiums for both small businesses and individuals have more than doubled in the past decade, and the escalating costs have created anxiety among many Americans.

But it takes the naivete of young idealists or the statutory cluelessness of the Congressional Budget Office to see how this bill will have any prayer of "bending the curve" of increasing health costs for the next decade.

I'm not even considering the "process improvements" and pilot projects incorporated into the bill.

I'm thinking about how we will actually pay for the cost of subsidizing access to health insurance for every American family earning below four times the poverty rate...beginning in 2014.

The vast majority of the financing for those subsidies are assumed cuts in the growth of Medicare reimbursements, which have never been enacted in the prior history of Medicare. Those cuts are typically threatened in any given year and restored before the year is over. Do we really think Congress will find the courage to do something which it has yet to find the courage to do in the 45 years since Medicare was introduced?

The other big source of financing is the so-called "Cadillac plan tax" on high-cost health plans. Originally scheduled to take effect in 2014, the House kicked that can down the road till 2018, by which time the cost of even a low-benefit health plan will probably qualify for an excise tax.

Proponents of the reform legislation like to point out the potential benefits to consumers which might materialize in the out-years after the bill takes effect. And there are some real benefits.

But even considering those benefits, it's hard to see many provisions of this legislation which will control health insurance costs for small businesses and the self-employed, and plenty of provisions which could lead us to real fiscal calamity. Once again the Congress has attempted to craft legislation creating a gigantic new entitlement without having the courage to pay for it (or, more specifically, to require US to pay for it).

And that's the embodiment of their confusion over the difference between passing a law and solving a problem.