In a story that analyzes prospects for major health care reform this year, Kaiser Health News
points to cost as the biggest challenge to reform and noting that, "the Democratic proposals could cost $1 trillion to $1.5 trillion over 10 years, and lawmakers are a long way from coming up with the money." The piece, which is posted on the McClatchy Washington Bureau's
Web site, raises the question of how forcefully Obama will push for such costly reform and then outlines three major scenarios: "Democrats win big," "crash and burn" and "half-a-loaf or less."
In the first scenario, the House and Senate pass health care legislation before the August break, Congress passes comprehensive health care legislation in late fall and Obama holds a signing ceremony shortly before Christmas. To do so, Democrats would need to remain unified while also picking up some Republican votes and tackling the contentious issue of taxes, dipping into "employer-provided health care benefits, which totaled $226 billion in 2008." Kaiser Health News reports that the result would most likely include "an insurance exchange," a kind of marketplace where individuals and businesses could buy coverage from private carriers or perhaps a new government-run plan. In addition, there would be requirements that all Americans have insurance, and that insurers sell coverage even to people with health problems. Employers would have to cover their workers or chip in something to help pay for the uninsured. Medicaid, the state-federal health program for the poor, would be expanded."
A second scenario could occur if politics and taxes prove insurmountable challenges. In that case, some moderate Democrats, Republican critics and industry officials could insist that universal coverage is unfeasible and that the plan is too expensive, depends too heavily on taxing the middle class and does too little to control spiraling costs. This may also occur if the industry and non-health care interests turn "against the overhaul effort, joining with Republican opponents and pumping cash into negative ads."
Kaiser Health News reports that a more mixed third scenario could also emerge "if determined to send Obama something, Democrats would patch together a scaled-back bill." It notes that, “Such legislation could still involve significant changes, but perhaps extended over a longer period of time, say 15 years, to stretch out the costs" (Appleby and Carey, 6/1).