Nearly universal health coverage

    What will Americans have to give up to get the health system they want?

    This week President Obama shared his healthcare-reform ideas and began to talk about the tradeoffs needed to give millions of Americans better access to health care. WHYY asked local experts what might develop from the President’s blueprint.

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    President Obama hasn’t proposed a specific reform path but has offered his guiding principles. He seems to embrace an increased role for government programs. But it’s lawmakers who execute the details, and they represent many competing visions.

    Experts in this region aren’t predicting an overhaul of the health system; but they are expecting changes in how we pay for care.

    Nash: The current policy scuttlebutt is clearly toward universal coverage one way or another.

    Policy expert David Nash says employer-based health insurance isn’t likely to disappear. That means insurance companies will keep their middleman role managing millions in health care dollars. But that role could be downsized.

    Nash is dean of the Jefferson School of Population Health. He says Obama will try to do more to help low-income people afford health care. The president is already asking wealthy Americans to pitch in through higher taxes. And Nash says people who have health insurance might see higher co-payments.

    Everybody has to have more skin in the game in order to achieve universal coverage.

    Labor unions have negotiated good health plans for their members. Groups like the Service Employees International Union worry their work will be undone. But SEIU’s secretary-treasurer Anna Burger concedes that alternatives have to be developed for people who’ve been priced out of healthcare.

    Burger: Having people outside the system actually costs us more dollars because it’s not as if people don’t get sick.

    Public health expert Walter Tsou worries that President Obama’s plans will lead to piecemeal coverage with insurance companies still excluding very sick people.

    Tsou: The system we have right now is discriminatory; it is the equivalent of a medical apartheid.

    Tsou’s a former Philadelphia health commissioner. He favors a single payer plan, an idea that sidesteps private insurance companies.

    Tsou: Right now you ask most physicians, they’ll tell you the current system is very onerous. There’s always this Mother, may I? permission-Simon Says mentality about doing health care.

    Tsou thinks less paperwork and a single-payer plan could control costs. But Americans may not be ready for such a radical change. Even Tsou doesn’t expect a single-payer plan to prevail right now.

    Health Economist Mark Pauly says Obama’s likely approach will be nearly universal coverage which is expanded access to health insurance without a guarantee or a mandate.

    Pauly is a professor of Health Care Management at The Wharton School. He says lawmakers should revive a plan from Senator John McCain.

    Pauly: Impose taxes on the health benefits that especially upper income workers get, which are currently shielded from income and payroll taxation and even the dreaded Philadelphia wage tax.

    If workers are forced to pay after-tax dollars for health premiums, Pauly says they might forgo pricier plans. He says the change would require bi-partisan cooperation, and concessions from labor unions.

    Pauly: There’s about $200 billion a year worth of tax revenue that could be tapped by removing the favorable tax treatment. Probably you wouldn’t want to do that politically, but at least there’s a large pot of money there.

    President Obama says he’s ready for the political fights ahead. Lawmakers are also expecting pressure from insurance and pharmaceutical companies. In the mid-1990s those lobbies undid the Clinton-Administration’s bid for comprehensive health reform. Dr. Walter Tsou says that may happen again.

    It’s not just President Obama, it’s actually all of Congress that has to be ready for that fight.

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