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Congress, Obama Missed Key Opportunity to Reform Health Care

by Mike Cassidy

They had a chance and they didn't take it.

The $787 billion stimulus package President Barack Obama signed last week gave Congress and the administration the chance to take a small step toward rebuilding a health care system that is illogical, inefficient and inhumane.

Instead, Republicans cried socialism, Democrats buckled and Obama surrendered.

Staying healthy has always been a crapshoot in the United States. There is nothing new about illness and disease visiting victims with a cruel randomness. The woman who has never smoked develops lung cancer. Her next-door neighbor, a former smoker, does not. Children come down with rare and mysterious ailments that leave us all heartbroken.

But increasingly, getting healthy again or preventing the diseases that can be prevented have developed their own cruel randomness. In the end, the final stimulus package only underscores how arbitrary our health care system has become.

Initially House Democrats proposed temporarily extending Medicaid to those who lose their jobs in this horrendous economic downturn. The bill also called for helping the unemployed extend their employer-sponsored health insurance through COBRA, provided they had that insurance when they were laid off.

The final bill dropped the provision to extend Medicaid to workers whose employers didn't provide health benefits in the first place. It kept the subsidy for COBRA, but also set up a potentially life-or-death lottery in which those who lost their jobs before Sept. 1 get no COBRA help while those who lost their jobs on or after Sept. 1 will have part of their health insurance bill paid by the government for nine months.

Why Sept. 1? Who knows? This stuff doesn't have to make sense.

Does it make sense to tie access to decent health care to the ability to land a decent job? What was the thinking on killing the Medicaid extension? No need to help the unemployed who didn't have health coverage in the first place because, hey, they're used to it?

Of course the original proposal was far from perfect. Nothing is easy, or cheap, when it comes to health care coverage. But as I argued in a recent column, the initial plan was a move in the right direction - the direction of universal, government-sponsored health care.

And the Medicaid proposal was temporary, which means it was a chance to try something new on a small scale to see how it worked.

The idea of government-sponsored health care scares conservatives to death. A few responded to my column with howls of protest. The general themes? Government doesn't get anything right. Universal health care will lead to the rich getting the help they need by paying out of pocket. The poor will suffer long delays for needed care. Government bureaucrats will interfere with health decisions.

As I wrote back to one such reader: The description sounds pretty much like the system we have today - although it's insurance companies that can't get anything right, and it's their bureaucrats interfering with medical treatment.

There can be no doubt that our current system is unworkable. About 45 million Americans are uninsured. The number in Silicon Valley is growing, according to the 2009 Index of Silicon Valley, issued by Joint Venture: Silicon Valley and the Silicon Valley Community Foundation. So is the number of valley residents buying their own policies, the index says.

Premiums for private insurance can easily reach $1,000 or more a month. It's a crushing cost for some who are working and simply out of reach for most who aren't. The stimulus bill gave the nation's leaders a rare chance to do something about that. And they failed.

They'll have to live with that - while the rest of us live with the consequences.

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