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September 2008
Health Care Reform High on the Agenda
By John Paul Galles

     Whether John McCain or Barack Obama is elected president, this political season is likely to produce great debates and big promises about health care reform. By 2017, health care spending will balloon to about $4.3 trillion or one fifth of GDP. That is almost double what will be spent this year, which is about 16 percent of GDP. With the aging of the baby boomers and the increasing American life span, our health care crisis is no longer a partisan issue.

     Nearly everyone understands that something has to change. And fast. Both John McCain and Barack Obama are promising radical change to totally transfer the way health care is delivered and paid for in the United States. Both political parties want to make health care affordable and stem the rampant increases in health care costs.

     Since World War II, our government has favored the delivery of health care to individuals through employers. Employers are now slashing or substantially reducing health care programs because they can no longer bear the costs of skyrocketing premiums and more individuals than ever are uninsured or underinsured. Senator McCain has recommended a kind of national insurance market that places more purchasing power with consumers. Senator Obama is encouraging more of a national health insurance that would be an expanded Medicare and a huge federal super-program. Neither one is a perfect solution.

     Regardless of who is elected, real and actual health care reform is extremely complicated. To get Congress and the president to act and agree is a monumental task in itself. Additionally, health care coverage is governed by different sets of rules. Major corporations are regulated under the Employee Retirement Income Security Act (ERISA). ERISA preempts any non-federal laws that relate to employee benefit plans.        
    
When larger corporations self-insure or partially self-insure, they are exempt from state statutes. Smaller companies and/or anyone purchasing individual polices are governed by state statutes and regulated by the particular state’s department of insurance. Importantly, if you want to change the way health care is delivered or paid for systemwide, you must make coordinating changes at both the federal and state levels.

     Many of us remember the efforts of Hillary Clinton in 1993-94 to reform health care. With Bill Clinton as a newly elected president, together they learned the hard way about pushing too much change much too fast. In addition, special interests were throwing money in all directions to discredit any and all reform measures. You can be sure that lobbyists are already gearing up for another health care battle extraordinaire.

    The lessons learned to date are that any health care reforms must be done in stages. To achieve systemic reforms like John McCain and/or Barack Obama have prescribed, major legislation must be enacted. Moreover, reform is most likely to be successful in the first term of a presidency when he/she has the most leadership power. We are at a pivotal moment where public participation is crucial. The Congress will not vote for legislation that the public deplores; nor will they vote against legislation that the public approves.

     That means you can contribute your ideas, provide your input and affect the process. You have a chance to elect people who believe the way you do on November 2. Don’t wait until next spring to let them know how you feel about health care reform. Make known your concerns now, register to vote and be sure to vote on November 2, and stay involved on important issues affecting your lives!

John Paul Galles is the publisher of Greater Charlotte Biz.
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