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Will August Be The Cruelest Month For Reform?

Well, this is shaping up to be an eventful August, despite Congress being in recess and half of the country being on vacation: Congressmen are getting shouted down by health reform opponents at town hall meetings. New details of the Senate Finance Committee deliberations are leaking out. And there's a rising tide of public unease about the reform bills that Congressional and Senate committees have adopted so far.

As some media accounts have pointed out, the people who have been raising ruckuses at local political gatherings are not all shills of the Republican National Committee and conservative anti-reform groups. Some have undoubtedly been aroused by Rush Limbaugh and other right-wing talk show hosts who have been making outrageous claims about the Democratic proposals. But the people who are complaining about "socialism" and a government takeover of health care are voicing concerns that have stopped many other reform attempts in the past.

What's different about the public opposition this time around is that it stands in stark contrast to the support for Democratic reform bills among other healthcare stakeholders. I've already written on this blog about how physician societies favor reform more than the public does. The American Hospital Association backs reform in general, although it is skeptical about the details. The pharmaceutical industry is said to be poised to pour $150 million into ads backing reform. The insurance companies, while they remain firmly opposed to the "public option," support reform and said months ago that they would be willing to stop excluding people from coverage for health reasons if everyone were covered. All of these sectors expect to benefit from a move to near-universal coverage.

Most employers--Wal Mart and Target excepted--oppose a mandate to cover their workers, but that is apparently not on the table in the Senate Finance Committee. Instead, the committee is discussing a requirement for employers who now provide coverage to continue to do so or pay into a "free rider" fund. In any case, very few large companies do not offer health coverage, and employers that do would benefit from government subsidies that helped people buy insurance, reducing cost shifting to corporations from providers that care for the uninsured.

That leaves John Q. Public, which is split down the middle about healthcare reform. Many people are concerned that they'll lose the insurance coverage they have, and that the services available to them will be limited under reform. Seniors are especially worried. Of course, both of these things are already happening and will only get worse if the status quo continues. But most of those who have insurance are only dimly aware of this fact.

Finally, there's the political equation in Washington. The Republicans are unalterably opposed to the public plan, but not all of them are just trying to shaft Obama and the Democrats. As Ezra Klein's excellent interview with Sen. Lindsay Graham (R-SC) makes clear, some Republicans, including Graham, would support reform that would help control costs and wouldn't increase the odds of a government takeover of healthcare. In fact, Sen. Graham says that he would vote for some version of the Wyden-Bennett bill, which would shift responsibility for buying coverage from employers to workers and would give the latter the money to do that in the form of a raise equivalent to their employers' current insurance cost.

While there are some problems with this measure, it deserves a second look. Not only would it provide much more financial support to people to buy insurance on their own than the "free rider" fund would, but it would also sever the connection between employment and insurance that has hampered individuals and our economy in so many ways.

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