Discussion for Chapter 4. Obama and Health Care Reform

After several months of emphasis on the economy (including the stimulus package, a budget, and forced restructuring of Chrysler and GM), President Obama is moving to press Congress to come up with a health care proposal. Based on the history of what presidents are able to accomplish when, he feels that he must get this done in his first year, or else the effort will be doomed. The major issues facing Congress are whether a public plan should be included as an alternative to existing private plans and then how to pay for the plan. The insurance industry is very much against any public plan and fiscal conservatives, including many Democrats, are against raising taxes to pay for the overall cost. Obama himself opposed McCain's proposal to allow health care benefits for employees to be treated like taxable income to help pay for expanded coverage. In case you were wondering how we ever came to have health insurance tied to employment (few other nations do this), it goes back to WWII when wages were frozen, so companies used health care insurance as a way of attracting employees. But even though Obama has said he did not want to tax benefits, many economists say that may be the only way to pay for a plan. Public opinion has in fact supported covering everyone in some way since the 1940s. But it has not been done. The last effort was Clinton's failed effort in 1994. Interestingly, almost half of Obama's staff worked for Clinton, so they think they can avoid some of Clinton's mistakes, one of which was waiting too long and trying to do it in a congressional election year. So far they have let Congress devise and consider several plans, but sometime this summer the White House will almost certainly have to get behind some plan and press for its passage.

You can find a number of editorials on this in the Washington Post, in the NY Times and elsewhere. Paul Krugman, a Nobel Prize winning economist, for example, strongly feels that Obama will eventually have to take on the insurance companies, who he feels add a lot of overhead to medical costs and are determined to undermine any plan that forces them to compete with a pubic plan (see http://www.nytimes.com/2009/06/05/opinion/05krugman.html?emc=eta1).

Ok, all that was background. Because about half of the people in this class are nursing students, what happens over the next few months will not only affect us as consumers, but also as health care providers. And of course what Obama is attempting to do depends on presidential power--he is very aware that power tends to decline the longer one is in office. So here is the question. What do you think should be done? This can be broken down into several subquestions. Should Obama be pushing for a health care system that somehow covers all Americans? Should insurance companies, which claim that they are efficient providers, have to compete with a public plan? And finally, how would you pay for such a plan? Would you prefer to cut the insurance companies out altogether and go with a single provider government sponsored plan? (You should know that Obama has already rejected that idea, much to the dismay of many liberals who want a government run plan.)