Why the GOP has no health care plan
The Hill reports that there is currently a debate within the GOP caucus as to whether they should offer an alternative health care reform bill.
In the current debate, if you ask a GOP politician what he/she would do to reform health care, you're likely to hear a lot of buzzwords, things like "portability" and "competition across state lines." This all sounds well and good. Competition is generally a good thing and most of us would prefer it if our health insurance wasn't tied to our employment. But when you try to reduce these ideas to policy, the result is a disaster.
There are two fundamental problems we face with our health care system. The first is the fact that tens of millions of people in this country are either uninsured or under-insured. The second is the fact that health care costs are rising rapidly. Any proposal to reform our health care system must address these problems.
The one idea that Republicans have offered to address these problems is relatively easy to understand. They want to allow private health insurers to sell policies across state lines. Thus, as long as an insurer complies with the regulations of its home state, it could sell insurance outside of the state. This would increase the amount of competition and thereby reduce premiums. The problem with this idea, of course, is that it would create an instant "race to the bottom." The insurance industry would lobby the states to relax their regulations and then would all set up shop in the state that was most willing to comply with their demands. The result would de facto deregulation of the industry. But, from the GOP perspective, this is a feature, not a bug. Without laws mandating what they have to cover, insurance companies would gravitate toward high-deductible, low-benefit policies that could be offered for reduced premiums. Businesses would start offering these kind of policies to their employees in order to cut costs and many individuals would choose such policies in order to save money on premiums. While this might reduce average premium prices (at least in the short term) and allow some people who currently can't afford insurance on the individual market to purchase it, the result would be a system in which just about everyone is under-insured.
But this is exactly what conservatives want. They believe (or at least claim to believe) that the reason health care costs are out of control is because people don't have enough personal stake in health care spending. The believe that if people have to pay a greater percentage of costs out-of-pocket, they will have an incentive not to "purchase" unnecessary care.
As anyone who has studied health care policy for more than ten seconds knows, however, treating health care like grocery shopping is a recipe for disaster. First, when it comes to health care, "consumers" simply don't have the expertise to be intelligent "shoppers." We're not doctors. We generally don't know what diagnostic test or procedure we need or when we need it. We don't know which doctor or hospital is the best "deal." We don't know which drug offers the most "bang for our buck." Most of us never will, either. That's why we have doctors. Moreover, when you make people pay for routine and preventative medical care out-of-pocket (as high deductible policies do), the inevitable result is that people don't get enough routine and preventative care. That results not only in worse health outcomes, but it drives up costs. It is much easier and cheaper to treat conditions if they are detected early.
On some level, I'm pretty sure that most Republican politicians know all of this. They know that their "principles" don't translate well into actual policies. They know that if they were to produce an actual bill, nearly every health care policy expert in the country would immediately point out its myriad flaws. And on some level they also know that the only way to effectively deal with the problem of the uninsured or to control costs is through greater (not lesser) government involvement in the health care system. Indeed, one of the final quotes in the article is very revealing on this score:
Some House Republicans are growing frustrated that their leaders have not yet introduced a health care reform alternative.The problem the GOP faces is a very simple one: it is impossible to translate their "principles" into a functional plan. This is why they never lifted a finger to address the issue of health care reform during the entire time they controlled the White House and Congress. Indeed, the one health care related bill they passed (the Medicare prescription drug bill) was a massive new--and completely unfunded--government entitlement, something that would seemingly violate any possible list of GOP principles in profound ways.
For months, the message from House GOP leaders on a healthcare bill has been similar to ads for yet-to-be-released movies: Coming soon.
According to several GOP lawmakers, the leadership is split over how to proceed in terms of unveiling an alternative to the final Democratic bill that Speaker Nancy Pelosi (D-Calif.) intends to unveil as soon as this week.
Rep. Tom Price (Ga.), chairman of the conservative Republican Study Committee (RSC), revealed the schism within his party late last week.
“There’s a difference of opinion over what ought to be the strategy from a political standpoint on this issue. I happen to believe we ought to have a bill. There are others who believe, as strongly, that the principles that would be outlined and would be adhered to in the Republican bill are what need to be discussed because everybody can embrace those principles,” Price said last week.
In the current debate, if you ask a GOP politician what he/she would do to reform health care, you're likely to hear a lot of buzzwords, things like "portability" and "competition across state lines." This all sounds well and good. Competition is generally a good thing and most of us would prefer it if our health insurance wasn't tied to our employment. But when you try to reduce these ideas to policy, the result is a disaster.
There are two fundamental problems we face with our health care system. The first is the fact that tens of millions of people in this country are either uninsured or under-insured. The second is the fact that health care costs are rising rapidly. Any proposal to reform our health care system must address these problems.
The one idea that Republicans have offered to address these problems is relatively easy to understand. They want to allow private health insurers to sell policies across state lines. Thus, as long as an insurer complies with the regulations of its home state, it could sell insurance outside of the state. This would increase the amount of competition and thereby reduce premiums. The problem with this idea, of course, is that it would create an instant "race to the bottom." The insurance industry would lobby the states to relax their regulations and then would all set up shop in the state that was most willing to comply with their demands. The result would de facto deregulation of the industry. But, from the GOP perspective, this is a feature, not a bug. Without laws mandating what they have to cover, insurance companies would gravitate toward high-deductible, low-benefit policies that could be offered for reduced premiums. Businesses would start offering these kind of policies to their employees in order to cut costs and many individuals would choose such policies in order to save money on premiums. While this might reduce average premium prices (at least in the short term) and allow some people who currently can't afford insurance on the individual market to purchase it, the result would be a system in which just about everyone is under-insured.
But this is exactly what conservatives want. They believe (or at least claim to believe) that the reason health care costs are out of control is because people don't have enough personal stake in health care spending. The believe that if people have to pay a greater percentage of costs out-of-pocket, they will have an incentive not to "purchase" unnecessary care.
As anyone who has studied health care policy for more than ten seconds knows, however, treating health care like grocery shopping is a recipe for disaster. First, when it comes to health care, "consumers" simply don't have the expertise to be intelligent "shoppers." We're not doctors. We generally don't know what diagnostic test or procedure we need or when we need it. We don't know which doctor or hospital is the best "deal." We don't know which drug offers the most "bang for our buck." Most of us never will, either. That's why we have doctors. Moreover, when you make people pay for routine and preventative medical care out-of-pocket (as high deductible policies do), the inevitable result is that people don't get enough routine and preventative care. That results not only in worse health outcomes, but it drives up costs. It is much easier and cheaper to treat conditions if they are detected early.
On some level, I'm pretty sure that most Republican politicians know all of this. They know that their "principles" don't translate well into actual policies. They know that if they were to produce an actual bill, nearly every health care policy expert in the country would immediately point out its myriad flaws. And on some level they also know that the only way to effectively deal with the problem of the uninsured or to control costs is through greater (not lesser) government involvement in the health care system. Indeed, one of the final quotes in the article is very revealing on this score:
One House Republican who spoke on the condition of anonymity said, “The fact is, [GOP leaders] are very concerned with doing anything that the base would interpret as ‘Democrat-lite’ or ‘socialized-lite’ … which is forcing a little of paralysis.”That paralysis is a consequence of the fact that, absent greater government involvement, there really is no way to deal with the uninsured or to reduce systemic costs. If the GOP were to produce a bill and submit it to CBO-like analysis, the results would undoubtedly show that it does almost nothing to address either problem. Indeed, it could very well be shown to make both problems worse. That's why there is no GOP health care plan.
posted by A.L. at 9:49 AM
28 Comments:
I'm a little confused here, because Rep. Price himself introduced H.R. 3400 on July 30 this year with some 50 co-sponsors i think including the leadership. So I don't exactly get this idea that they have "no" legislation available. But it must not be very good or they would have made a much bigger noise about this before now.
Now I'm not a policy wonk and while I've struggled thru reading great swaths of H.R.3200 to understand the truth instead of the lies, I have no great desire to wade thru this on my own. I've advocated on Daily Kos that I thought the house democratic leadership and committee chairs should have sent this or any legislation the republicans put forward on to CBO for scoring precisely because as you succinctly point out it would probably be found out to be both wanting and costly and mostly ineffective. The dems get the advantage of being able to say that they are willing to consider all ideas, but hey, the republicans ideas just sort of, you know, SUCK! And the public including the wingnut base gets to see what actual repub legislation looks like and how shitty it actually is compared to what the dems are offering. And as you point out, they have been promising all summer to produce their own version but except for Rep. Price, the only other thing we've seen have been two page press releases spouting republican principles.
If they were smart, they'd avoid an ideologically pure bill and get the entire House and Senate caucus behind Wyden-Bennett. Lining up behind an existing, reasonable plan that's at least more "conservative" than what will pass given an uninterrupted trajectory of meaningless obstructionism would stand a good chance of temporarily derailing the bill.
The best strategy, by far, is to find a bill that lowers deficits as much as possible and jump on it. Then the GOP can go into 2010 comparing their plan's budget implications with what passed.
AL- yesterday Christina Romer said that the tax on high-price insurance plans is “'probably the number one item that health economists across the ideological spectrum believe is likely to stem the explosion of health-care costs.” Why would that be? Because the higher the level of insurance, the greater the incentive for the patient to spend on health care since he or she (in your words) “doesn’t have enough stake in health care spending.”
Is this evidence that Romer has spent less than ten seconds studying health care policy?
'So I don't exactly get this idea that they have "no" legislation available. But it must not be very good or they would have made a much bigger noise about this before now.'
It's not that there are no health care plans written or sponsored by Republicans. It is that the Republican Party has not, itself, advocated any of these plans and none of these plans has widespread support among Congressional Republicans. The health care plan with the most high profile Republican support is one by loony Democratic Senator and alternative medicine advocate Ron Wyden of Oregon (Wyden has a Republican co-sponsor, but this bill is his and was originally written during the Clinton Era health care debate.)
The bills by Tom Price and Tom Coburn (and friends) have far smaller knots of supporters and Judd Gregg's 'CPR', the most 'Republican' of all the Republican health care plans, garnered such little support among conservative Republicans of Gregg's own stripe that Gregg abandoned it and signed onto the Wyden-Bennett bill.
MLS,
Romer is actually supporting my point.
There's a huge difference between discouraging so-called "cadillac plans" and encouraging bare-bones, high-deductible plans.
For instance, many "cadillac plans" allow patients to see specialists without any referrals. That's wasteful and ineffecient precisely because patients generally have no idea what they need. It's far better to have a low-cost primary care practioner function as a gatekeeper, thereby reducing unnecessary trips to specialists.
But for the very same reason, you don't want a plan that discourages people from seeing their primary care doc for routine and preventative care (because patients don't know what they need). Virtually every Republican plan would do exactly that.
If I understand what you are saying, government subsidy (ie, through tax preferences) of health care insurance is a good thing, but only up to some level (which the Congress will identify based on its usual scientific method), at which point it becomes a bad thing.
Now did you just make that up, or can you cite some expert who believes that?
MLS,
What are you talking about? I didn't say anything like that. I wasn't making a point about taxes at all. My point is that health care policy-making is very complex. There are a myriad of ways in which you can play around with incentives for both patients and doctors. But when you do that, the goal should be to reduce wasteful spending while improving quality of care. I have no problem with taxing wasteful plans as a way to encourage better, more effecient ones. But I think Republican policy proposals that would encourage high-deductible, low-benefit policies are (for similar reasons) a really bad idea. I think that instead of discouraging wasteful spending, such policies would discourage patients from getting necessary (and ultimately cost-saving) preventative care.
When it comes to health care policy, you can't reduce everything to simple bumper stickers like "competition good" or "taxes bad" etc. Health care is much more complex than most industries. You will always have third-party payers (public or private insurers) and expert intermediaries (doctors) affecting all decision-making and their presence distorts incentives and often creates very unhelpful practices.
For instance, market forces drive insurers to do things that increase long-term costs. To take one example, since people typically only stay in a plan for 3-5 years (because they change jobs, etc.), insurers have incentives to discourage consumption of routine care and push off the day of reckoning. That's not healthy or cost-efficient in the long term. There are all sorts of similar examples if you read the literature.
The only way to make a system work is for the government to play a major role in correcting such market failures. This is why Medicare was necessary. This is why Medicaid was necessary. And it's why we also need a number of the reforms proposed in the health care bill.
AL- if government is going to try to decide who should get what health care and at what price, then health care policymaking will be very complex indeed. For example, on the radio today I heard that Congress is trying to decide how much more insurers can charge people based on age. One bill says that insurers can charge older people twice as much as they charge younger people, while another bill says they can charge four times as much. Needless to say, I expect that Congress will make this decision on a completely arbitrary basis, but even if the decision were being made by experts with the best of intentions, I sincerely doubt that their decision would improve on the market.
You suggest that it is a wasteful practice for patients to be able to consult specialists without referrals. Probably so, but I would suggest that this is a symptom, rather than the disease. These types of wasteful practices exist because the government, through the tax code, encourages employers to pre-pay their employees’ health care costs. If it were not for this subsidy, most employees would take their compensation in cash, and would not pay for gold-plated insurance policies.
By eliminating the most expensive plans, Romer hopes to cut down on these wasteful practices. But note that the problem is not “expensive” plans per se; if people want to use their own money to buy more expensive plans, it should be of no concern to others. The Cadillac tax is correcting a problem that the government itself created. (Indeed, as I understand it, it applies only to employer-provided plans.) Of course, these wasteful practices are not limited to Cadillac plans, but it is politically impossible to eliminate the government subsidy for all employer plans (and it may turn out to be impossible to do so even for the Cadillac plans).
I take your point about the importance of preventative care, but I think that may be a mistake to deal with this through the insurance system. Preventative care really doesn’t have anything to do with insurance (it might if insurance companies were able to reduce their expected costs by encouraging such care, but as you point out it doesn’t in fact work that way). It might make more sense to focus on the public health benefits of preventative care for everyone, including the millions who will remain uninsured even if Obamacare passes.
This is a specific instance of a general problem with the Obamacare concept. We are using insurance companies to do everything except the one thing that they are supposed to be good at, i.e., evaluating and pricing risk. IMHO, this is a flaw in our current system that “reform” will just make much worse.
Are health care costs really rising that rapidly - or are insurance premiums rising? I have the feeling it's the latter.
Same with the tort reform canard: payout has remained stable for a while but premiums for doctors have gone way, way up every year.
Regarding the issue of selling insurance across state lines, AL states:
"The problem with this idea, of course, is that it would create an instant "race to the bottom." The insurance industry would lobby the states to relax their regulations and then would all set up shop in the state that was most willing to comply with their demands. The result would de facto deregulation of the industry."
Why couldn't the federal government establish a regulatory floor through federal regulation of the industry?
Eclectic Radical - "The bills by Tom Price and Tom Coburn (and friends) have far smaller knots of supporters and Judd Gregg's 'CPR', the most 'Republican' of all the Republican health care plans, garnered such little support among conservative Republicans of Gregg's own stripe that Gregg abandoned it and signed onto the Wyden-Bennett bill."
My sense is that generally health care has never been a priority for republicans the way it has for democrats since the basic philosophy seems to be work hard and make enough money that it's not a problem for you. But that doesn't provide answers to those who for whatever reasons don't succeed to that level. But the dems are missing an opportunity to highlight both the lack of workable HCR ideas AND the division between the different factions (i.e. far right and delusional right). Opening up this view to public discussion could help the progressive cause I believe.
And mls: "We are using insurance companies to do everything except the one thing that they are supposed to be good at, i.e., evaluating and pricing risk. IMHO, this is a flaw in our current system that “reform” will just make much worse." I disagree - they are very good at evaluaationg and pricing risk. This is why they drop you or jack your premium sky high if you get a catastrophic illness. It's why we need to create Medicare because they were pricing old people who consume lots of health care out of the market. health care isn't like pricing risk for fire insurance where it's relatively cheap to take corrective measures to fix hazards.
And Jeff - I don't see why the public option doesn't satisfy the whole selling across state lines issue. Once you've met the basic requirements for the exchange that policy could be sold anywhere. And H.R. 3200 allows companies to offer Basic, Plus, Plus-Plus, and Platnium levels of policies in the exchange. The extra offerings should in theory offer the insurer the opportunity for increased profits above the basic plan if people want to pay for the extra coverage. I have never seen this pointed out anywhere else.
I find it interesting that A.L. decides to do a meaningless deflection of the real issues regarding this health care legislation. It isn't that the GOP doesn't have a health care plan, it's that they have as many as the Democrats who control Congress.
There are three Democratic bills that have been passed out of various House committees, and two Democratic bills that have been passed out of two Senate committees. Most of the media has concentrated on how the Senate will vote, whether there are enough votes to get a compromise bill past cloture (too many Dems are against this, along with Lieberman). But, there isn't even a final bill that has gone through the House; word is, there aren't enough House Democrats, despite the 70-member majority, who would vote for it.
The bottom line is there is no bill that has been provided by Democrats, let alone Republicans. And in the House, the Democrat "leadership" has no problem freezing out Republicans, although that may bite them procedurally.
Here's the funniest statement in the post:
...there really is no way to deal with the uninsured or to reduce systemic costs. If the GOP were to produce a bill and submit it to CBO-like analysis, the results would undoubtedly show that it does almost nothing to address either problem. Indeed, it could very well be shown to make both problems worse. That's why there is no GOP health care plan.
The CBO has already analyzed the Democratic bills and guess what? None of them, except maybe the Baucus bill, addresses either problem either. Even the Baucus bill relied on the passage of another bill that paid doctors many of the costs the Baucus bill took out. Except, that bill didn't pass cloture, and by quite a large margin.
Here's another funny part. A.L. and other health "reform" supporters talk about how "experts" have discussed how to make their "reforms" some kind of cost-effective and meaningful policy. There is only one problem with that; none of those "experts" seem to know anything about Congress or how Congress works. Experts may know how to build a better mousetrap, but Congress would figure out a way to screw it up. So it really doesn't matter how many people have been working on this issue, or how long they've been working on it, because whatever they do still has to go through Congress.
For A.L. and others, it is much easier to make claims that Republicans don't have a plan, deflecting from the real problems with this health "reform" legislation. Of course, based on A.L.'s own parameters, neither do Democrats. But you won't read anything from him that says that.
Here's the other thing that A.L. and others won't mention: health care costs will continue to increase, and everyone's taxes will increase. They'll spin it that neither of these things will happen, but that is delusional.
""if government is going to try to decide who should get what health care and at what price, then health care policymaking will be very complex indeed.""
Oh my...when will this stop. No one has put forth an argument for or a bill empowering government to do what you say. The policy suggestions by the democrats have all centered on allowing the individual to make those choices, but more importantly, to be given the possibility to make them. The role of government here is not to make the choice but to offer the choices. "Government takeover" crap is just GOP deflection. As AI makes very clear, the GOP do not have a policy alternative and hence do not have a sensible argument against the Democratic plan. That does not mean you have to do the same.
Lets get this done.
you know the conversation is going down hill when Steve gets involved.
indeed.
Charlie
"Are health care costs really rising that rapidly - or are insurance premiums rising? I have the feeling it's the latter"
premiums are rising *because* costs are rising. In order to understand why costs are rising, you need to understand how each of the forces in our healthcare system exert pressure on each other to increase costs. We are basically in an upward spiral that goes like this:
1. We have X uninsured. the majority of these people are not uninsured by choice, but because they can't afford it. when these people have medical emergencies, they generally have to go to the hospital, where costs are extremely high for treatment. in many cases, they will have to receive uncompensated care.
2. When hospitals give out uncompensated care, they have to make up the cost somewhere else. They do this by lobbying local, state and federal government for grants and subsidies, OR by increasing the price of their services.
3. When hospitals increase the price of their services, Health insurance companies, being the chief payer of those costs, now have to raise premiums to cover the increased cost of paying for hospital services.
4. When Health insurance companies increase their premiums, this prices a new portion of the populace out of the Health insurance market, and the amount of uninsured grows.
5. When the number of uninsured grows, this increases the number of people that hospitals will have to provided uncompensated care to, and they raise prices again. In this way, the cycle repeats itself.
this cycle is basically why healthcare costs are increasing so rapidly. How do you stop the cycle? I believe that some form of single-payer system is necessary. Having the government insure its own people stops the cycle. Does it result in higher taxes? yes. But it also reduces the cost of providing healthcare. You don't even have to take my word for it either: it is generally an accepted fact that America pays ~30% more per capita for healthcare than any other nation in the world.
I'm not advocating that we put the government in charge of everything. Britain basically does that with the NHS and their healthcare system has a ton of problems. I do believe that the government needs to insure its own people to prevent costs from spiraling out control like they are now. The ONLY way to stop this spiral without adopting socialized healthcare is literally to stop providing care to the working poor and let people suffer and/or die. If we are not willing to accept this reality, then we must accept that providing care to people costs money. and if we're unwilling to let them die for being unable to afford medical treatment, then we've already effectively socialized healthcare anyways; we've just done so in a fashion that is horribly inefficient and puts upward pressure on costs, as the above relationships pretty clearly show.
A.L.
There is a surreal quality to your writing on this topic. We have not tried any of the reforms that conservatives propose nationwide, and yet you conclude that they would be impossible to implement or that if implemented they would fail. Yet states like Texas and Mississippi have introduced conservative reforms like tort reform, and doctors are now moving back to those states that they were once fleeing and insurance premiums are declining. Meanwhile, states have also implemented many of the reforms that are in the Baucus bill, and the results are much higher insurance premiums and private insurance companies generally fleeing the states that have imposed the guaranteed issue, community rating, and more. Massachusetts has seen exploding costs that will have to be borne in part by the federal government. Given that record, I would like to see more of conservative reforms taken up countrywide, and less of the liberal ones.
Here's Peter Suderman chronicling the failure of liberal health policies in the states that have already tried them.
http://online.wsj.com/article/SB10001424052748703298004574455560453947646.html
Notice that Boston Globe reports that employers--faced with the surging costs--will be opting for plans that cut benefits to their employees or have their employees take on more of their own health spending. In other words, the Massachusetts Plan (which is essentially the Baucus Bill) does exactly the same thing that A.L. accuses the conservative policies of: dropping benefits while increasing the amount they have to pay out of pocket (hello wage reductions!)
Notice that in Maine, with their version of a public option, costs are exploding and the number of uninsured remains essentially the same. Notice that in Tennessee, the state opted to slash 170,000 people from their insurance rolls because the state was on the verge of bankruptcy. But let's ignore all of this evidence and implement disastrous liberal policies on a nationwide level! No thanks.
What if We The People joined the race to prevent and cure disease by owning our own pharmaceutical research labs? Surely, we'd be first to discover many new and lucrative new weapons in the war on disease, and we could sell them to ourselves at reduced prices.
In the race to find ways to defend ourselves against disease, why aren't we allowed to run for ourselves?
> Are health care costs really rising that rapidly -
> or are insurance premiums rising?
Both.
Hi all,
Why are there so few references to experience from existing socialized medical systems? I thought that man's greatest asset, aside from his brain, was its use in analyzing past experience, and synthesizing a solution.
We have both need-based one-payer system with basic fee thresholds, and private "quick-access and more options" insurance programs here in Sweden.
The major form of complaints here are due to lack of resources (too few radiation facilities) and thus long waiting lists.
Perhaps looking elsewhere involves more effort. Of course, but it might open up for quicker or unique solutions.
Hi everyone! I hope you all had a Happy Halloween. Have I missed anything… like the usual concerned conserva-trolls that always manage to pop in and tell us how Obamacare will be the death of us all? Hmmmm… let's see…
Well, I see that mls was here to misstate the case once again. For instance:
AL- if government is going to try to decide who should get what health care and at what price, then health care policymaking will be very complex indeed. For example, on the radio today I heard that Congress is trying to decide how much more insurers can charge people based on age.
I heard on the radio that Grover's Mill, New Jersey was being attacked by aliens so I rushed the wife and kids down to the basement. Later, the neighbor called and said it was a just radio play. Boy was my face red!
And there's the ever amused SteveAR to tell us that…
The bottom line is there is no bill that has been provided by Democrats, let alone Republicans.
Well… except for the 3 House bills and 2 Senate bills that he mentioned earlier. But those are scary ghost bills that clang their chains and stomp their feet on the floors of Steve's cerebellum.
New visitor, Timothy weighs in with the observation that…
There is a surreal quality to your writing on this topic.
The central concept of A.L.'s piece; that Republicans are missing in action when it comes to offering any real solutions, is straight from the pages of the Necronomicon!
Actually, the truly horrible thing is that our conservative commentator friends won't bother to address why the GOP hasn't bothered to present a plan to counteract the horrors of Obamacare. All the Republicans have to do is set pen to paper and write a bill.
Sure, it won't pass, but they can put their proposed policies out for all to see and judge their effectiveness. They can have medical savings accounts, tort reform, remove those burdensome restrictions on insurance companies and throw in a big fat tax cut for the rich.
They can unite behind it and drive a stake through the heart of "liberal health care". But they won't write it. Why?
Because they're too scared.
Anon Y Moose- I love sarcasm as much as the next guy, but you might want be a little more judicious in your use. It is true that I said that my information came from the radio, and it is true that the radio is sometimes the source of misinformation, but, no, it doesn’t follow that my information was wrong. In fact, you can read/listen to the piece in question, “Health Care Pools: Let Youth Jump, Or Push Them?,” on NPR’s website.
If you are too lazy to do any actual research, you might try common sense. If Congress is going to force younger people to subsidize the health care of the middle-aged, it is going to have to limit the ability of insurers to offer cheaper policies to younger people. Otherwise, the market would force the premiums of younger people down to levels at which there would be no subsidy.
Now it is easy to disparage the workings of the market when you are implicitly comparing it to some sort of idealized process in which the price of medical goods and services are set by all-knowing and disinterested policy experts. It isn’t quite so easy when you consider how Congress actually makes these types of decisions.
I'm trying to interpret your comments in the most positive light, MLS, but it sounds like you are suggesting that those who need health care the most and can least afford it should subsidize each other.
If the healthy (which, as you grow older, you learn is almost syonymous with "the young") don't subsidize those in need of care they can't pay for, who will? And if they don't get subsidized, under the existing laws they get subsidized in the least efficient manner possible, via emergency rooms.
If your plan is to just let the elderly die, you could have the honesty to just say so. If you are going to invoke some market magic that will take care of the problem, please be advised that the experience of the entire world over the last 60 years indicates that you are in denial of reality.
A.L., your post begs the question as to what existing problem Conservatism offers a solution for. It's not just health care. In today's rapidly changing world, Conservatism is like standing in the path of a flood and commanding the water to stop. It offers nothing but a mindless refusal to deal with, or even to recognize, that the solutions of yesterday will not solve the problems of today, let alone tomorrow's.
What's needed is not Conservatism, but pragmatism -- and there's precious little of that to be found in the GOP today. More than enough naked opportunism, quite a lot of anti-intellectualism, and a significant amount of flat out idiocy, but not much pragmatism. Pragmatism is, after all, essentially a liberal trait.
MLS, all you are doing is explaining why the market is so bad when it comes to covering people's health care needs. The very same market forces you are describing (that would make the young pay less) are what make old people virtually uninsurable and are the reason we had to create Medicare in the first place.
Indeed, it's the same kind of market forces that make it impossible for people in flood or hurricane zones to get home insurance from the private market. That's why the government has to step in.
The only type of system that could ever possibly cover everyone at rates that everyone can afford is a system in which the government either acts as the insurer (Canada) or HEAVILY regulates the industry (Israel, France, Netherlands, etc.) so as to distribute the burden. The young HAVE to subsize the old. The healthy HAVE to subsize the sick. There's no other way to do it.
A.L.,
As anyone who has been paying attention to the long-awaited delivery of the "GOP health care reform proposal" now knows, your prediction was amazingly accurate.
It would cover almost nobody not already covered, and it would save less than the competing Democratic bills.
It's not often we see such predictive accuracy in politics. I'm impressed, even though I already thought you were right, on the whole.
The GOP does not represent the republican point of view anymore.
I have tried to begin a discussion about what a real republican health care system might look like. Please take a look - I hope to begin a deeper and more systemic discussion about what can be done outside the halls of government to help people be well.
http://justinholmes.com/2009/10/resistors-of-socialized-medicine-must-offer-a-more-systemic-vision-of-health-care
here in florida if a doctor cant get malpractice insurance to practice due to cost he or she can purchase this insurance from the state of florida. this insurance is pooled to allow for this. now, what i dont understand is, if doctors have a public option to do business, why cant i have a public option to not die?
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