WASHINGTON — The shaky state of the health care system appears to be driving a sense of urgency and compromise in the debate over comprehensive reforms, lawmakers said at the American Medical Association's annual advocacy conference.
Putting partisanship behind them, a group of senators has introduced a bill “built on the fact that both Democrats and Republicans have been right on key parts of the issue,” said Sen. Ron Wyden (D-Ore.).
The Democrats have been right to insist that everybody be included, while the Republicans have been right about involving the private sector, the senator added.
The Healthy Americans Act (S. 334) would shift the responsibility, but not the cost, of purchasing private health insurance from employers to individuals in recognition of the need to modernize the employer-employee relationship. Employees want portable coverage that will follow them through jobs and employers are seeking better control over costs, he said.
“Ron Wyden has a good plan. There's a lot of it that I agree with; there's a lot I adamantly disagree with,” said Sen. Tom Coburn (R-Okla.), a practicing physician. He also noted that a key principle is “to truly create access in this country.”
Despite that seeming common ground, Sen. Coburn has sponsored a competing proposal, the Universal Health Care Choice and Access Act (S. 1019), which would similarly disentangle employers from the business of providing health insurance for their workers. The bill would allow individuals to claim the tax benefit linked to purchasing health insurance and currently only available through employer-sponsored coverage. It would also create a tax credit to, in effect, subsidize the cost of health insurance for low-income people and cap the tax cut that higher-income people get.
“Today, the very wealthy get about $18,000 worth of tax benefit and the very poor get about $100 worth of tax benefit,” according to Sen. Coburn.
Both Senators also called for increased emphasis on prevention and early detection through realignment of the reimbursement system.
The major area where the senators differed was over how much the government should be involved in setting standards both for individuals and the health care industry in general.
Sen. Coburn said that once the opportunity to access health coverage was created, it would be the responsibility of individuals to take advantage of that. In contrast, Sen. Wyden's bill would require companies to contribute to and workers to purchase health coverage. In addition, Sen. Wyden's proposal contains a guaranteed issue provision to make insurers offer coverage to all comers, whereas Sen. Coburn's preference is to rely on a free market to determine supply based on demand.