By an act of coincidence, one of the elite voices of the health care debate spoke in Ketchum on Monday at a lecture planned more than a year in advance.
The timing was perfect. Less than 24 hours earlier, Congress had approved a $940 billion bill extending health care to tens of millions of uninsured Americans. On Tuesday morning, President Barack Obama signed the bill into law.
Donna Shalala has long been involved in the contentious issue, having served for eight years as President Bill Clinton's secretary of Health and Human Services, the longest of anyone. In 2008, President George W. Bush awarded Shalala—currently president of the University of Miami—the Medal of Freedom for her work to improve wounded veterans' care.
On Monday, Shalala stood in front of a packed house at the Presbyterian Church of the Big Wood and tackled the overwhelming 2,500-page health care bill, presenting it as something the common person could understand.
"I do want to say I've read the bill," she said, joking that she is one of five people to have done so.
She said the bill's main purpose is to extend health care insurance to the more than 32 million uninsured citizens.
"And 80 percent of the people who are uninsured go to work," she said.
She said those people just can't get insurance through their employer and are usually low-income. She said the bill makes health insurance "affordable," a word the makers of the bill made sure to define in print. She said the bill outlines—for individuals—a maximum health insurance cost of 9 percent of income. The less money one makes, the lower that percentage falls. For example, low-income individuals would pay a maximum of 3 percent.
However, Shalala said, the vast majority of the bill's plans won't be implemented until 2014 because the states need time to "organize." She said a few provisions would be immediate, such as allowing children to be on their parents' insurance until age 26.
She said insurance companies currently prohibit college graduates from staying on their parents' insurance.
"And after college, this generation tends to wander," she said.
They don't get jobs right away and, therefore, usually don't have health insurance coverage.
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She said the bill's main funding mechanism would hit individuals making more than $200,000 a year or couples filing jointly who make more than $250,000. And a new Medicare tax would apply to unearned income such as dividends and rents.
Shalala said very few government leaders, Republican or Democrat, are against providing quality and affordable health insurance to everyone.
"Half of all bankruptcies in this country relate to health-care costs," she said.
The dichotomy arises in whether the government should get involved and oversee the entire health care system. Does the bill extend too much regulatory powers to the government?
"I think it's a good question to ask," Shalala said. "Is it a good role for government? We can argue whether it's too much regulation, but we shouldn't argue whether to provide health insurance to the working class."
But, Shalala asked, when do we want government to "intrude" into our lives?
Social Security answers the question. That government-controlled system financially supports the retiree population where a private-sector alternative doesn't exist. And, she said, the private sector of health care is defunct.
"Anyone that has good health insurance is paying for someone that doesn't," she said.
For example, when an uninsured person or illegal immigrant goes to the emergency room, the hospital must serve them. The patient can't pay for treatment so the insured population is stuck with the bill.
"We need to balance that out," she said, later adding, "We all end up paying for it in an inefficient way, anyway."
Shalala used the University of Miami as an example. The university employs 14,000 people.
"When I was told insurance costs were going to increase 11 percent, I hit the ceiling," she said.
She said the country needs to fix the broken system. And having everyone covered is a start.
"We've got to get our arms around the whole health care system by getting everyone covered," she said. "Then, we can worry about cost containment."
However, she said, health care ultimately comes down to taking responsibility for one's own health.
"If we could just get people to eat right, exercise and not smoke, we could pay for health care and have tons of money left over," she said.
Trevon Milliard: tmilliard@mtexpress.com
Former Secretary of Health and Human Services Donna Shalala talks about health care at the Presbyterian Church of the Big Wood in Ketchum Monday night. The lecture was organized by the Ketchum-based Sun Valley Center for the Arts. Photo by Willy Cook
