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Seal the health care deal


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POSTED: Monday, December 28, 2009

Senate approval on Christmas Eve of health care reform legislation brings Congress a step closer to enactment of universal care, approaching that provided in all other industrial democracies. Both House and Senate bills would mandate employer-based health insurance similar to a successful Hawaii system that was put into place more than 30 years ago and should be left intact.

Bills in both chambers would achieve President Barack Obama's goal of extending coverage to nearly all Americans. The differences between the two bills are controversial but can and should be resolved to make way for universal care that includes more than 30 million presently uninsured people and prevent denial of insurance because of preexisting conditions.

Both bills include provisions that would exempt Hawaii law that assures health care coverage at least as broad as that provided in the federal plan. However, Hawaii's law includes a provision that it would “;terminate ... upon the effective date of federal legislation”; providing for mandatory prepaid health care for Hawaii residents. That raises questions about whether the state's system will survive, let alone be exempt from some federal requirements.

Provisions of the Senate and House bills differ over coverage of abortions and whether a federally operated plan be included to compete with private insurance companies. Those issues should be resolved in time for enactment by the time of President Obama's state-of-the-union address in late January.

The so-called government option included in the House bill is likely to be set aside. House Speaker Nancy Pelosi, D-Calif., has said she would accept the Senate bill's creation of two or more insurance plans operated by private companies and overseen by the U.S. Office of Personnel Management, which handles health insurance for federal employees, including members of Congress.

Time will tell whether the federally overseen plans inject enough competition into the market to reduce the price of insurance premiums. If not, Congress should amend the law to require health insurance to be nonprofit, an approach that has been effective in Germany and other countries in keeping prices down. Republicans have called such a system socialistic, which it is not.

“;Premiums are out of hand,”; says Sen. Dianne Feinstein, D-Calif. “;Chief executive salaries are out of hand. Administrative costs are out of hand. My bottom-line belief is that the health insurance industry should be nonprofit.”;

That must wait for another day. The priority now is to put into place a federal health care system sought since the administration of Theodore Roosevelt.