Healthcare: Now What?

Healthcare: Now What?


It’s been a bad week for Democrats. Republican Scott Brown won the special election for the Senate seat formerly held by Sen. Ted Kennedy, leading to predictions that the House and Senate will not be able to cram through their strictly partisan health care reform bill. To add to the nervousness already felt by the Dems, the Supreme Court struck down components of campaign finance reform that favors incumbents and Democrats specifically.

But the GOP shouldn’t sit back and gloat. There is a unique opportunity to actually work with the Democratic leadership and get some things done that remain popular with the American people. And failure to act on them may expose the GOP to the same anti-incumbent mood that swept them from the majority in 2006. USA Today reports:

A 55% majority of Americans say President Obama and congressional Democrats should suspend work on the health care bill that has been on the verge of passage and consider alternatives that would draw more Republican support, a USA TODAY/Gallup Poll finds.

. . .

An overwhelming 72% of those surveyed Wednesday say Brown’s victory “reflects frustrations shared by many Americans, and the president and members of Congress should pay attention to it.” Just 18% say it “reflects political conditions in Massachusetts and doesn’t have a larger meaning for national politics.”

What kind of reforms should the GOP put forward? There are a number of blocked proposals the Dem leadership should now allow on the floor for debate. From the website:

For more information about some of the other common-sense health care reforms proposed by Republicans, please visit the links below:

The Heritage Foundation, a leading conservative think tank, explains these bills further, and points to several “guiding principles” that Republicans can support in other proposals:

Tax Equity: Today, if an individual purchases health insurance through their employer, they receive unlimited tax breaks on the value of their insurance. But if you purchase your insurance on your own, you receive no such benefit. This is inequitable and regressive. Ideally, Congress could replace the current tax exclusion with a system of universal tax credits. But at the very least, Congress should provide tax relief for those who purchase coverage on their own, and redirect other health care spending to help low-income individuals and families purchase private health insurance coverage.

State-Based Reform: Every state is different when it comes to health care challenges. Some states face high rates of uninsured citizens while others face spiraling costs. Instead of a federal one-size-fits-all approach, Congress should embrace federal-state partnerships that preserve diversity in the states. The states could devise their own way to achieve reform, like a mechanism for portability (i.e. take your insurance from job to job). Individuals should also have the freedom to purchase insurance from any trusted source and not be restricted by where they live (i.e. buying insurance across state lines).

Entitlement Reform: Not only are Medicare and Medicaid increasingly costly, they’re not delivering value to American taxpayers. If health providers could compete directly for the business of seniors and the poor, the cost-curve would truly be bent and private innovation would flourish. Right now, the tsunami of entitlement spending is on an automatic course for disaster, with locked-in spending, and more to come. Long-term costs of entitlement programs must be built into the annual budget process so Congress can no longer ignore the crisis that is continually pushed off on future generations. Americans can no longer blindly pay into an entitlements system that offers little incentives to providers to offer better value to the consumer and the funding taxpayer.

There is a difference between saying “no” to a bad plan, and just saying “no”. The task for the GOP will be to come up with common sense alternatives that people can support.

Cross posted to

  • Nick Benjamin

    Did you read the GOP website?

    The Empowering Patients First is supposed to give everyone access to affordable coverage. But it’s a huge pile of BS. It’s paid for by tort reform, tax credits, and a permanent 1% reduction in non-defense discretionary spending. In other words it’s only paid for if you seriously believe Congress will fire 1% of the INS, and cut farm subsidies 1%.

    Moreover it has a “high risk pool.” That’s a fancy way of saying there will be two insurance plans. One affordable one for those of who don’t need it. Another, extremely expensive one, for folks who do. By expensive I’m talking $800 a month. Many states already do this and it has not worked very well for any of them.

    The rest of the bills are just as silly. If it was this easy Dubya would have done it.

    I can understand not believing Congress will actually follow through on the cost controls in ObamaCare. But they are there, and they’re as close to Congress-proof as they can possibly be. The GOP bills don’t even go that far. If you don’t believe Obama you can’t believe the GOP. Period.

  • Chris

    “What kind of reforms should the GOP put forward?”

    I won’t hold my breath.

  • Jim S

    First, every Republican proposal has one thing that is necessary to believe they will work. It is membership in the First Church of Free Market. You have to believe blindly that free market principles work for everything and are incapable of failure. They can do no wrong. Every one of these proposals counts on this in order to achieve the claims they make. One thing you also have to do is be willing to lie about the efficacy of “tort reform” in reducing costs. No one outside of the ideological right wing thinks that law suits and malpractice insurance constitute enough of the cost of health care to make a significant difference.

    Also, the Republicans do not want entitlement reform, they want entitlement elimination. If you really think that corporations are just waiting for their creativity to be set loose in order to help the poor I’d like to hear an explanation for the poor neighborhoods in America’s cities that can’t get any major businesses to locate there. But of course there is no explanation that would honestly address the incompatibility between conservative beliefs and what happens in the real world.

  • kranky kritter

    Well, there’s really no way I’m clicking through and reading 8 links. Too foreboding and potentially time consuming. I require executive summaries before I click through. If the republicans really have any good ideas, I’ll wait for them to bubble up. In the meantime, no credit for filing bills with wonderful-sounding names. If that makes me sort of a jerk, oh well.

    One thing I do know is that I don’t support pouring more resources into prevention and wellness. This is likely to contribute to more cost increases. I support controlling costs. Wellness and prevention have merit in terms of improving outcomes, but there’s no research I’ve see which shows that they really do have a “stitch in time saves 9” effect. Instead, most research suggests that while they can improve outcomes somewhat, they cause costs to rise.

    Ongoing annual healthcare cost rises in the 8-10% range are simply not sustainable. The pain has already emerged for most non-wealthy employed Americans in the form of paying a bigger percentage of the total cost, higher deductibles, caps and limits on coverage, more prevalent nickel and diming. When costs double again over the course of the next decade, we’ll have no choice but to belly up and do something really serious.

    Some of the stakeholders will be big losers when that happens. Will the losers be poor people? Or sick people? Peole who lost their jobs? Small businesses? Big businesses? My money is on the big losers being whoever has been making the most money off of healthcare spending: insurance companies, pharma, and some provider subgroups. And healthcare workers to some extent as well. I see more people working in healthcare, but at lower wage levels than today.

  • Jim S

    Yeah, I had already read up on the “plans” that Frank linked to. If it wasn’t so sad that some people probably think they’d really work they’d be funny. What the Republicans and insurance companies don’t seem to realize is that when none of the things they say will help really accomplish anything the backlash will be huge.

  • Frank Hagan

    Some things do work, guys. Did you really read even the first paragraph of the first proposal linked? Tax credits for insurance works; if it didn’t, we wouldn’t have employer sponsored health care. A dollar for dollar reduction in taxes for the cost of health insurance can be paid for by a reduction in withholding by increasing exemptions. The net cost to the worker without an employer plan is very small. Allowing civil associations to set up group insurance also makes sense; co-ops of church members, credit union members, etc. can all leverage extra buying power.

    That’s in the first link.

    Of course, none of these proposals give the Federal government the power to set wages for medical personnel, decide who gets treatment and who doesn’t, etc. Whenever I hear the phrase “bend the cost curve down” I know its a euphemism for “bend over.”

  • Nick Benjamin

    I read the summary you linked to, and the PDF of the slightly more detailed summary it linked to.

    Here’s what I didn’t see that I was looking for:
    1) Every tax credit reduces government revenue. The bills did not give a ballpark figure for how much the credits would cost. This implies that they have not thought about how much these credits would cost, which in turn implies their proposal is not serious.
    2) Many of the uninsured and uninsureable in the US do not pay taxes. You can’t fix the healthcare system for those folks with tax credits. Period. You have to expand Medicaid. Maybe they don’t care about poor folks, or maybe the proposal is not serious.
    3) There was no specificity on cost controls in either document. Obama’s cost controls can be pretty vague, but at least he gives you a general idea about where they’re coming from, and who gets to decide what costs to cut.

    This is not a proposal to fix health care in the US. It’s a bunch of platitudes listed together so the GOP can pretend it has ideas on health care.

    As for “bending the cost curve” if you have an idea to reduce cost growth that will work without Federal intervention please present it. Key words: will work.

    If you have some brilliant plan that allows us to avoid national bankruptcy without bending the cost curve please present it. As long as it will work.

  • Chris

    Or perhaps the easiest solution: move to canada lol.

  • kranky kritter

    Some things do work, guys. Did you really read even the first paragraph of the first proposal linked? Tax credits for insurance works; if it didn’t, we wouldn’t have employer sponsored health care. A dollar for dollar reduction in taxes for the cost of health insurance can be paid for by a reduction in withholding by increasing exemptions. The net cost to the worker without an employer plan is very small. Allowing civil associations to set up group insurance also makes sense; co-ops of church members, credit union members, etc. can all leverage extra buying power.

    That’s a great point Frank. And it suggests the kind of blog post that I personally prefer. My criticism is really an editorial point about attracting audience. I generally feel unmotivated to click through to anything on a “round-up post” with a big list of links unless I have an enticing hint of what I might find there. You did provide expostion below the linked, but the relationship between that exposition and the links about isn;t all that clear.

    IMO, your post would be better if it immediately focused on one particular idea you liked, and had some decent info on that, and THEN concluded with a “here’s some info on other ideas worth considering” list. Arguably, ALL of the information that came after the round-up list should have come first, in a separate post. THEN, you could have done the round-up list AFTER that as a separate post, beginning with a graf about the one you liked best.

    As a textbook editor, I see that as a more solid and inviting approach. YOu describe some general principles briefly, and invite discussion. THEN you look at possible real-world applications.

    I often log on in a low energy state, and look for ideas that sound like they might get my juices flowing. While posts that help readers find relevant information are useful, I think a blogger is well served to try to include something which gets the regulars talking.

    Notice what kind of comments round-ups can draw. You post may give the appearance to some of just trying to show a volume of conservative ideas to counter the “party of no” vibe. Which invites the sort of extremely predictable and equally content-free response that Jim jumped in with. Notice how Jim’s content provides active discouragement to any liberal reader, suggesting that clicking through isn’t worthwhile.

    If your post had begun with the sort of specific content-based argument that your later comment had, there’d be some basis for a dialog. Remember, people don’t always read all the way through.

  • Jim S

    The tax credits as proposed by the Republicans just bear no resemblance to what people actually have to pay for insurance in order to have coverage that is comprehensive enough to prevent economic shocks so severe that people would have to file bankruptcy or have their credit rating destroyed.

  • David

    How about reminding everyone that health insurance != health care?

    Most proposals I see are related to the former, not the latter; however, they use emotional arguments about access to the latter to advocate changes in the former.

    The reform I’d like to see is simple and inexpensive: require any provider of medical services to fully post retail prices up front and in advance. This would only be as hard for doctors as it is for automobile mechanics, and it would at least begin the process of educating individuals about the actual retail cost of the services they use. That’s the first step towarwd allowing people to shop based on price. Right now, only providers who don’t directly deal with insurance companies post their retail prices, and I’d like to see that changed.

  • Jim S

    Agreed, David. While I don’t think shopping around will be the panacea that some think there’s still no reason for that kind of transparency to not exist.

  • Nick Benjamin

    The problem with that is simple: only uninsured people actually pay retail price. Insurers exist specifically to negotiate discounts, frequently extremely steep discounts, so the “retail price” is designed to be a starting point for negotiations with insurance companies, not an actual retail price.

    If you don’t believe check out your next Medical bill. Unless you’re uninsured the price on the bill is a fraction of the price the insurance company actually pays.

  • David


    Baby steps…

    Actually, it isn’t quite true that only the uninsured pay retail – consider that there are lots and lots of physicians in the DC area who do not participate with ANY insurance (i.e. they’ll give you a form you can go submit yourself). Also, having retail prices listed is a starting point, and at least *begins* the process of allowing price comparison between vendors.

  • wj

    Then, of course, there are those of us who pay retail because, while technically we do have insurance, what we have is catastrophic insurance: it covers medical expenses above a (very) high annual deductible.

    Why have only that? Because the premiums for anything more comprehensive, for those who don’t get employer-based insurance, are way higher than someone below the median income can afford.