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Published: Tuesday, Oct. 20, 2009 / Updated: Friday, Oct. 30, 2009 11:14 AM

Answers to reform questions

Dear Editor,

James G. Winters Jr. has written me a letter regarding health care reform, which the Fort Mill Times published on Sept. 30. I have summarized his questions and answered them as follows:

1. Why is this legislation being pushed through Congress so fast?

Health care reform is hardly on a “fast track.” Three House committees and two Senate committees share jurisdiction of health care. All five have held hearings, the first starting as far back as February. Since June, the three House committees have marked up bills, but withheld bringing anything to the floor. There were ardent members who wanted to go to the floor in July before Congress recessed, but there were wary souls (like myself) who argued for a slow-down, and we prevailed. So the bills remained on the shelf, accessible to anyone, through August and September. These House bills will be merged into one, and brought to the House floor, probably by the end of this month. In the meantime, the bills are a work in process, still subject to alteration. In the Senate, the chairman of the Finance Committee spent much of August and September, trying to find common ground for a bipartisan bill. When the House committees settle on a final bill, it will go to the House floor for lengthy debate and amendment, and when the Senate passes its bill, it too will go to the Senate floor for even longer debate and amendment. The two bills will be full of variations, which will have to be worked out in a conference, and the conference could last for weeks.

In short, if the health care reform bill that began in February ultimately becomes law, it is unlikely to happen before November or December, which means the better part of a year will have been spent on the subject.

2. Why is so much of the content of this legislation hidden from the public?

This process can hardly be called hidden. As I write, the Senate Finance Committee is working its way through the chairman's mark, amendment by amendment, with all of the proceedings covered live by C-SPAN. The House counterpart has been in print and open to the public for weeks, along with a number of guides and summaries. All five committees have websites, where copies appear, most of which are down-loadable. The Congressional Budget Office has published cost analyses of all the proposals, and copies of its reports appear on its Web site, www.cbo.gov. Under the scrutiny being paid these bills, it would be hard to hide anything.

3. Why don't we learn from the mistakes of other countries that have nationalized their health care systems?

The reforms being considered do not come close to “nationalization.” They build on our existing system of employer-sponsored health insurance, and extend coverage through an insurance exchange. The exchange features a variety of policies underwritten by private insurance companies. A nationalized, single-payer system could have been created by expanding Medicare, but this is an option none of the bills pursues.

We have learned a few positives from other countries. We have found, for example, that if we repeal the Bush Administration's ban on negotiating the price of prescription drugs, and bargain like other countries, we can save billions of dollars that can be used to make affordable health care benefits for the uninsured.

4. The administration has been “bad-mouthing” our medical system. The U.S. has the longest life expectancy of any nation. What is this legislation supposed to improve upon?

I have not heard the president “bad-mouth” our medical system, and you certainly have not heard me do so. I have two daughters, two sons-in-law, and two first cousins who are physicians, and I think we have the best medical care in the world; but it is also the most expensive, about 40 percent more expensive than the next nearest nation. We cannot sustain a medical system whose cost is 17 percent of our Gross Domestic Product and growing, and yet millions of people are left out, lacking insurance coverage. What do we have to improve upon? Widening coverage while holding back cost—which is a challenge, no doubt about it. But if health care reform were easy, it would have been done long ago; and if we do not do it now, the cost of care and the number uninsured will only increase.

5. The U.S. health industry has led the world in innovation. How will this continue if no one can afford to work on global problems like AIDs and cancer?

None of the bills pending in the House or Senate dictates prices, especially prices below cost. They do call for price restraints, but medical costs are running well ahead of inflation and need to be restrained. As for research, the National Institutes of Health is funded this year at record levels, supplying the dominant share – nearly $40 billion – of all that is spent on research in cancer and AIDs and numerous other diseases. The pending bills also support subsidies for “graduate medical education” at approximately $9 billion a year, or around $100,000 per physician in residency. This is where the excellence in our medical system starts--with the excellence in medical education–and the pending bills carry on the tradition of strong federal support.

6. If the Obama Administration's plan is so good, why not let employees and employers opt in or out?

This is just what the so-called “public option” proposes. If health care reform passes, most employees would continue to be covered under employer-provided group insurance policies, but those who do not obtain coverage through their employer would have the right to purchase it at group rates through an insurance exchange, with premiums scaled according to income. The insurance exchange would offer a variety of different policies. Terms would vary, but all would contain the same core coverage. If someone does not like his insurance company's terms or quality of service, he would have the option of obtaining coverage under another policy or under a public policy. No one would be forced to elect either one. Everyone earning less than 133 percent of the poverty level would be covered by Medicaid. Everyone else would be required to carry medical insurance, much the same as automobile liability insurance, but there would be a range of choices. One of those choices could be a public policy–the idea is not yet agreed upon–but no one would be forced to take this option.

7. If the plan is so good, why is Congress not covered by it? Is this like Social Security which we are “stuck” with, and you are not?

Congress and other federal workers participate already in an insurance exchange called the “Federal Employees Health Benefits” program. The insurance exchange proposed by the pending bills is modeled after this program, and would work much the same way. Multiple companies offer policies, which have the same core coverage but varying terms. Members of Congress pay 27.5 percent of the premium cost. Because the federal system is so similar, it will probably be integrated into the system created by the pending health care bills.

As a member of Congress, I pay and participate like other Americans in the Social Security system and receive the same benefits, and always have. I am not exempt, but I do not feel “stuck.” I think Social Security and Medicare are two of our country's crowning accomplishments.

8. Where in the Constitution is the federal government's granted power to enact Social Security, Medicare, and Medicaid?

Article I, Section 8 of the Constitution (the spending clause) empowers “Congress....to lay and collect taxes and duties....to provide for the common defense and general welfare of the United States.” The power to tax and spend for the general welfare is among the broadest powers granted by the Constitution, and has been the basis of health programs like Medicare and Medicaid, and more recently, the Children's Health Insurance Program.

The commerce clause of the Constitution also empowers Congress “to regulate commerce...among the several states.” This has been interpreted expansively and today applies to anything “with a substantial relationship to interstate commerce.” This would support the changes in health insurance underwriting that are part of health care reform.

These clauses of the Constitution have upheld the legality of Medicare and many other health care programs, and should also sustain health care reform.

John M. Spratt Jr.

Member of Congress

District 5