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Published: March 22, 2009
President Barack Obama stumbled with his plan to ask veterans to use their private insurance to pay for combat injuries and disabilities.
After putting forth the proposal, he was forced to scrap it after strong protest from veterans and members of Congress.
But why did veterans have to get up in arms to convince the president it was a bad idea? What happened to the vaunted Obama populist savvy? The idea of imposing a third-party - insurance companies - into the medical care of wounded warriors goes against the American grain.
In his second Inaugural Address a few weeks before the Civil War's end, President Abraham Lincoln set the bar for his exhausted country's - and the U.S. government's - obligation: "to care for him who shall have borne the battle and for his widow, and his orphan."
Lincoln's phrase became the motto for the Department of Veterans' Affairs.
The root cause of the unpopular insurance idea is, of course, money.
The ever-rising cost of health care is a slippery issue Obama and Congress eventually will have to grasp and subdue. But any politician would have to be tone deaf to think it's a good idea to save money on the backs of veterans with combat injuries.
The administration hoped to save upwards of $500 million a year by billing veterans' private insurance for their service-related medical care. The American Legion and service groups cried foul, saying the government should continue to provide the care.
Critics worried that the change might make it hard for war-wounded vets to obtain care if service-related injuries became a pre-existing condition under private insurance.
David K. Rehbein, national commander of the American Legion, emerged from a meeting with veterans' groups and Obama on Monday and said, "He says he is looking to generate $540 million by this method, but refused to hear arguments about the moral and government-avowed obligations that would be compromised by it."
Writing in an op-ed in The Wall Street Journal, Rehbein imagined the answering system at an insurance company, if the change were to occur:
"If you were injured in Iraq or Afghanistan and you have not paid your co-pay, please press 1. If you were injured during military training and you have not yet reached your deductible, please press 2. If your family has reached its maximum insurance benefit, please call back after you have purchased additional coverage. Thank you for your service."
A chilling prospect, to be sure. Veterans with war-related injuries and disabilities should be and are a special case. Obama dropped the plan Wednesday after members of Congress sent him a letter vowing to kill it.
The episode says a lot about the problems Obama will face in trying to rein in health-care costs generally while expanding coverage for 47 million uninsured.
Douglas W. Elendorf, director of the Congressional Budget Office, testified to a health subcommittee in the House earlier this month on options for controlling the cost and increasing the efficiency of health care. There weren't many of the former, and the latter are likely to be unpopular.
Health care spending is a double whammy. "The available evidence suggests that a substantial share of spending on health care contributes little if anything to the overall health of the nation, but finding ways to reduce such spending without also affecting services that improve health will be difficult," Elendorf said in prepared remarks.
When Obama dropped the insurance proposal, veterans breathed a sigh of relief. But the administration still wants to find that $530 million or so a year somewhere. Some groups, including the American Legion, support allowing Medicare to reimburse the VA for medical care of wounded warriors.
To sweeten the deal with vets, Obama's new budget provides for a $25 billion increase in funding for the VA over five years. This will allow the VA to serve an additional half million vets by 2013, according to VA secretary Eric Shinseki.
That's good news for veterans. But it won't solve the larger problem of health care access and cost. Each solution Obama and his policy wonks think up likely will have its own grassroots constituency, ready to mobilize at the click of a mouse to stop change they don't believe in.
Comment at mgwashington.com or e-mail mmercer@mediageneral.com.
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