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Tuesday, May 20, 2014

At last, a real health care debate

Posted By on Tue, May 20, 2014 at 4:00 AM

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The confused response to Indiana Gov. Mike Pence's proposed plan to expand the state's medical coverage for the poor shows how much Obamacare has changed the American political dialogue - and is likely to continue changing it.

Pence, a conservative Republican whose flirtation with running for president in 2016 has elevated his national profile, announced May 15 that he wanted to expand the Healthy Indiana Plan - HIP - so that it would provide health coverage to an additional 350,000 Hoosiers.

Pence and other conservatives tout HIP as a market-driven answer to Medicaid. Perhaps the biggest difference between HIP and Medicaid is that HIP requires the poor to have "some skin in the game," to use Pence's phrase, by paying a nominal fee for the coverage. If the poor don't have any skin to spare, they get shifted to another, more basic plan.

Because the Indiana governor has been such a loud and persistent critic of President Obama's health care reform efforts - and because his contemplation of a presidential run has been about as subtle as a Madonna concert's allusions to sex - Pence's proposal drew national attention.

Curiously, though, neither the criticism nor the praise seemed to be defined along partisan lines.

Forbes magazine and the conservative think tank the Heritage Foundation labeled Pence's plan a mistake and said the Hoosier governor should walk away from Obamacare in all forms. The Washington Times, a conservative newspaper, praised Pence for coming up with a GOP-friendly alternative to Obamacare.

On the other side, The New York Times and The Washington Post saw Pence's proposal as a sign that yet another GOP governor was quietly acknowledging reality and softening his opposition to Obamacare.

Still others made the argument that distinguishing between HIP and Medicaid was the same as establishing a distinction without much of a difference.

There doubtless is some truth to all of these arguments, but they all, to a certain degree, miss the most important point.

And that is that the president's health care reform package has challenged everyone, Republican and Democrat alike, to think anew about how we provide medical care and how we pay for it.

I remember a conversation I had with a couple of doctors a year ago, not long after the president's second inauguration.

Neither doctor was a fan of either the president or, in its particulars, Obamacare. Both men emphasized that they'd voted for Mitt Romney.

But they also both said that the president's health care reform plan had done one essential thing. It had forced a national conversation about health, about costs and how about how we deliver medical care.

"I have to give Obama credit for that," one doctor told me. "He made health care something politicians had to confront instead of something they struggled to avoid dealing with."

The doctor was right.

If the federal government approves Pence's proposed HIP expansion, it will extend health-care coverage to 350,000 Hoosiers.

But those 350,000 Hoosiers without meaningful health coverage didn't just suddenly appear. They have been here for decades - along with 30 million to 40 million other Americans who didn't have health insurance and for whom a major or lingering illness was an economic disaster in waiting.

Republicans such as Pence fought Obamacare with ferocity from the beginning, but their efforts to derail the president's plan faltered in large part because they never advanced their own plan to meet the needs of those 30 million to 40 million citizens. They lost the national debate over health care because they offered only criticism, not an argument or an alternative.

Because Obamacare is likely to be an enduring reality - and because the enrollment and financial numbers for the program show it isn't the disaster Republicans banked on it being - conservatives such as Pence now are grappling with creating alternatives to and refinements of the president's plan.

Critics can and will carp that they're joining the discussion a little late, but better late than never.

In part because Obama did force the conversation about health care, we Hoosiers - we Americans - finally are getting what we needed from the beginning.

A debate, and not a shouting match.

John Krull is director of Franklin College's Pulliam School of Journalism, host of "No Limits" WFYI 90.1 Indianapolis and publisher of TheStatehouseFile.com, a news service powered by Franklin College journalism students and faculty.

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