Who Will Be In Congress in 2020?

Did you know that the Federal Employees Health Benefits (FEHB) didn’t cover contraception until 1998—decades after most Americans had accepted “the Pill”?  FEHB did cover other prescription drugs and devices, but not birth control. Congress just didn’t approve

The government does not provide insurance to federal employees directly. It contracts with hundreds of private sector insurers to provide a menu of policies—some good, some not so good.. But Congress does lay done some rules.  As Naomi notes in her post below the plans cannot pay for abortions—even though many other private sector plans do provide coverage.

This is one reason why I like the idea of a hybrid health care system, private sector alternatives competing with Medicare E (for everyone).

We have no way of knowing who will be the majority leaders in Congress ten years from now—or who will be in the White House.  It’s not a stretch to assume that if legislators are willing to ban abortion for federal employees they might refuse to cover it in a single-payer health plan that covered the entire nation..

In the first budget that he sent to Congress President George W. Bush even tried to remove contraception from a list of products covered by FEHB. If Jed Bush became president would he nix covering contraception under a single payer insurance plan? (Remember Governor Bush’s role in the Karen Schiavo case)  Or maybe he would only ban contraception for women who aren’t married.  I don’t want to find out.

Of course, even if we had single-payer national health insurance, it’s likely that private sector insurers would sell “supplemental policies” –covering extras that aren’t included in the government plan. Perhaps private insurers would offer abortion insurance– for those who could afford a supplemental policy—assuming that those insurance companies weren’t too squeamish about bomb threats.  If Congress refused to include abortion in a national plan, I have to think that anyone trying to sell what would quickly be labeled  “abortion insurance”  would become a special target.

As regular readers know, I firmly believe that President Obama’s hybrid plan for universal coverage should include a government plan that is modeled on a new, improved and reformed version of Medicare. And I am quite sure that this Congress will include contraception in any government plan. . (I doubt President Obama would sign the plan if they didn’t.  But I wonder—will government health insurance cover abortion?)

As Naomi points out:  “Abortion opponents and the religious right are worried that Obama’s campaign call for coverage of ‘comprehensive reproductive services’  will mean that abortion—along with contraception and non-abstinence based sex education—will be part of the plan.”

We’ll see what happens. But I do think single-payer advocates should consider the fact that in a democracy, we really don’t know who will be running our government down the road. Sometimes American voters make excellent decisions. Sometimes they don’t. 

Finally, even if legislators never try to impose their moral values on  national health insurance, a  fiscally conservative Congress might decide to take an axe to health care spending—slashing without thinking. Think of what Margaret Thatcher did to the UK’s National Health Service. It’s still recovering. .  This is one reason why I would like to have private sector alternatives (preferably non-profit insurers) to a government plan—just in case we run into another bout of  “bad government.”

8 thoughts on “Who Will Be In Congress in 2020?

  1. This is a nice point, and I don’t think I’ve seen anyone articulate it before.

  2. Indeed, Senator Kennedy will be proposing a ‘hybrid’ plan today, although I am suspicious. I don’t think he really wants a hybrid – I think he wants government to run the whole thing. What does Obama want? See latest posting at http://www.MDWhistleblower.blogspot.com. Remember the health care reform miracle they promised us in Massachusettes? The miracle is morphing into a morass.

  3. We should all be taking a good look at the “choice” of plans offered to federal employees, and at the various state employee plans, esp. in Secretary Sebelius’ home state, Kansas. As you say, the plans are not all good. I’ve been hearing complaints from lower-income federal employees who say they can’t afford the least expensive option–especially family plans.
    Zeke Emanuel has said he would envision a basic public plan modeled on the federal employee plan(s). As you suggest, Maggie, we need to take a hard look at what that would include/exclude–and what might happen down the road.
    [Of course, Zeke has also said we are wasting our energy attacking the greed of the private insurance companies. I can think of no better focus for our energy.]
    I nearly jumped out of my chair when one of Diane Rehm’s guests on NPR compared zealous proponents of single payer to zealots on the abortion issue. At the time, I thought the linking of “single payer” with the word “abortion” was a deliberate attempt to discredit single payer. But maybe it’s a question we should address in order to defuse the issue up-front.
    HR 676, the House single payer bill, would cover all “medically necessary” procedures.
    I’ll have to look at how the Ontario Ministry of Health covers abortion. Ontarians can, of course, choose their own doctor and likewise a faith-based hospital.
    As Malcolm Gladwell has said, we can learn a lot from Canadians.

  4. Michael & Harriette–
    Michael, I’m curious.
    How do you know what Kennedy really wants?
    Yes, we do need to look into Federal Employees plans.
    I’ve done some reserach, and plan to write a post.
    But bottom-line, they are pretty expensive. The goverment doesn’t seem to have negotiated much of a discount from private insurers.
    And the less expensive ones have very high deductibles and other problems. . .I wouldn’t want them for my family.
    This doesn’t mean single-payer is the answer.
    (Single-payer could easily be teh federal employee insurance for everyone–if that is what government decided to do. If this Congress favored single-payer, that is almost certainly what they would do–farm the whole thing out to private for-profit insurers.
    See what I write about non-profit private sector insurers in part 2 of the Gawande post which is going up this afternoon.
    I would not want to lose them. Many of them are better than Medicare. They would set a high bar for Medicare for Everyone to compete with –which is what we need–insurers competing on high quality at an affordable price–not just competing on price.

  5. Maggie, I don’t understand this paragraph in your response to me:
    “Single-payer could easily be the federal employee insurance for everyone–if that is what government decided to do. If this Congress favored single-payer, that is almost certainly what they would do–farm the whole thing out to private for-profit insurers.”
    I don’t understand how single payer aka “one payer” aka ‘Medicare for all” could be farmed out to for-profit insurers. Unless you mean turning all plans into Medicare Advantage plans–which taxpayers are now subsidizing much to President Obama’s chagrin.

  6. , Harriette–
    Right now, when people in Congress talk about a public sector n option competing with private insurers, many favor something like the Federal Employees Plan, which farms it out to for-profit plans (much like Medicare Advantage, as you point out.)
    The other model for a public sector option is Medicare E (for everyone.)
    I greatly favor Medicare E. The Federal Employees model seems, to me, a terrible idea.
    But if this Congress seriously considered single payer (which I very much doubt) I am afraid that the “compromise” would be to have the government farm out the whole thing to private insurers with the govt’
    paying the bills.
    This would be terrible and the opposite of what you and I want.
    But “single payer” means many different things to many people just as “public sector option” means different things to different people.

  7. Like so many who advocate – you only present one side, trying to present worst case from your perspective only! The partisans who we elect to congress ON BOTH SIDES advocate for their MORALS not just the ‘right’..the lefties are trying to enforce their morals on us too! But presenting a fair picture is not what you are trying to do – is it?