… well, maybe not. The thing has a way of reviving when least expected. Still, yesterday’s votes in the Senate Finance committee represent large and serious defeats.
What follows now? For Republicans, one big decision: deal or no deal?
Until now, the threat of a government-run healthcare plan has deterred Republicans from negotiations with the administration. They were (reasonably) afraid of being mousetrapped into a philosophically unacceptable deal. But if the single most threatening element of such a deal has been voted down by Democrats, the field looks different. Instead of worrying about worst-case scenarios, Republicans now can begin to think: are there things we want? Might we successfully wedge centrist Democrats away from the Chuck Schumers? Until now, Republicans have clung to the untenable healthcare status quo in great measure because they feared the likeliest alternative would be worse. But what if the alternative might be an improvement over the status quo? Suddenly the deal option begins to look a lot more interesting.
36 responses so far
1 Derek // Sep 30, 2009 at 9:23 am
Why don’t you explain what the “threat” of gov’t health care is, which isn’t even being proposed by anyone? Every metric I look at shows single payer systems are much cheaper, and they give better results.
2 balconesfault // Sep 30, 2009 at 9:24 am
David, your analysis assumes that Republicans ever intended to work with the Dems at all.
http://www.washingtonmonthly.com/archives/individual/2009_09/020072.php
there are other areas in which Democrats simply embrace policy ideas endorsed, or even created by, the right. For quite a while, conservatives liked the idea of giving an Independent Medicare Advisory Council more power to determine what the program should pay for. It’s a straightforward, money-saving measure. When the Obama administration agreed, Republicans decided they didn’t like their own idea anymore.
and
a month ago, Chuck Grassley … announced that the way to get universal coverage is “through an individual mandate.” He told Nightly Business report, “That’s individual responsibility, and even Republicans believe in individual responsibility.” Earlier this year, Grassley told Fox News that there wasn’t “anything wrong” with mandates even if some may view them “as an infringement upon individual freedom.”
last week: Iowa Sen. Charles Grassley, the Finance Committee’s senior Republican, said the mandate is among the reasons that he couldn’t support the bill despite months of negotiations with Mr. Baucus. “Individuals should maintain their freedom to chose health-care coverage, or not,” he said.
I think that the author of that piece – Steve Benin – nails it when he writes: Congressional Republicans could probably save themselves a lot of trouble by simply saying, “Whatever Democrats are for, we’re against,” in response to every question.
3 Is It Time For Republicans To Jump On Board Healthcare Reform? | Conservative Cabbie // Sep 30, 2009 at 9:46 am
[...] David Frum in response makes an interesting suggestion. Now might be the time for Republicans to jump aboard: Until now, the threat of a government-run healthcare plan has deterred Republicans from negotiations with the administration. They were (reasonably) afraid of being mousetrapped into a philosophically unacceptable deal. But if the single most threatening element of such a deal has been voted down by Democrats, the field looks different. Instead of worrying about worst-case scenarios, Republicans now can begin to think: are there things we want? Might we successfully wedge centrist Democrats away from the Chuck Schumers? [...]
4 SpartacusIsNotDead // Sep 30, 2009 at 10:34 am
Frum wrote: “Until now, Republicans have clung to the untenable healthcare status quo in great measure because they feared the likeliest alternative would be worse.”
Let’s be perfectly clear, Republicans do not oppose reform because it will produce results that are worse than the untenable status quo. They propose reform because the only possible way to achieve meaningful cost savings on a wide-scale basis is through the use of a public option, which offends Republican ideology.
Republican opposition is purely about ideology – not actual real world results. There is abundant evidence that a public option (or substantially similar program) will produce better outcomes and cost much, much less than our current system. And, there is no evidence that a public option will drive private insurers out of the marketplace. California has long had a public option in the workers compensation market and private insurers continue to thrive in the market.
Republicans appear to care more about ideological purity than they care about reducing the financial burdens on businesses, individuals and the government while, at the same time, providing low-cost insurance to every American.
5 balconesfault // Sep 30, 2009 at 10:56 am
They propose reform because the only possible way to achieve meaningful cost savings on a wide-scale basis is through the use of a public option, which offends Republican ideology.
It’s not just that it offends Republican ideology. It also offends the goals of the insurance industry in America. As such – there are a handful of Democrats who are opposing the public option, seemingly not out of ideology, and certainly not in response to their constituents, if you believe polling – but because the insurance industry is seeing this as their Thermopylae and is pouring massive amounts of money into the campaign.
6 nwahs // Sep 30, 2009 at 11:27 am
What ever happened to the idea to make insurance more portable – not linked to a job? I think if most insurance was individually purchased rather than provided through employers, the consumers of insurance ( the insured) would affect pricing more. Let employers pay their workers more and let their workers choose their own insurance. I get the feeling the insurance industry isn’t interested in that degree of competition, and that’s why that idea is being quietly swept away.
7 balconesfault // Sep 30, 2009 at 11:55 am
What ever happened to the idea to make insurance more portable – not linked to a job?
Well, there is a chain of interrelationship.
To make insurance more portable, you need a guarantee that all companies will accept pre-existing conditions at an affordable price. And companies aren’t going to give that guarantee unless there is federal regulation to make all of them do it – so they can all raise their rates in concert to account for the increased risk pool.
If you mandate that all companies need to accept pre-existing conditions, then insurance companies are going to demand an individual mandate. Otherwise, there is the inevitability that individuals will go without coverage until they are diagnosed with some serious, costly to treat ailment, and then will apply for insurance.
**************************
That said, as I’ve argued before, I think that the US moving to a system where individuals purchased their insurance individually would be the fastest pathway to a universal system of coverage – much quicker than the slow erosion of large insurance’s market share by the introduction of a public option that Sinz fears. The “I got mine Jack” justification of many who are covered by employee paid insurance but who are not ideologically predisposed to oppose a national system will disappear overnight … and in a few years of dealing with your open market I suspect that there would be a groundswell for a government run option available to all.
8 Derek // Sep 30, 2009 at 12:14 pm
Conservatives are no longer interested in things that work better, and cost less.
9 sinz54 // Sep 30, 2009 at 12:14 pm
spartacusisnotdead:
FALSE.
Opposition to health care reform remains strong among the GOP base, even without a public option. Go to RedState.com or TownHall.com and see for yourself.
First, ideologically they are opposed to government mandating anything, such as mandating insurers to take applicants with pre-existing conditions, or mandating individuals to purchase insurance even if they don’t want to.
Second, they don’t trust Obama, Pelosi and Reid personally. Anything that they’re in favor of, the GOP base will reflexively oppose.
Thirdly, there’s a fear that once health care reform is passed, Americans will like it and become dependent on yet one more Federal program. And that might make Americans more enthusiastic about other liberal initiatives, and less enthusiastic about free-market proposals. Liberals have said the same thing: They see health care reform as a showpiece for what Big Government can do for average folks.
10 sinz54 // Sep 30, 2009 at 12:20 pm
nwahs & balconesfault:
Another difficulty with this idea is that it would collide with the existing concept of managed-care provider networks. In Massachusetts where I live, Harvard-Pilgrim offers a very good HMO plan. But all the doctors in their network of providers are in New England.
If I had Harvard-Pilgrim insurance, I couldn’t take it with me to Ohio or California, because Harvard-Pilgrim has no doctors from those states in their network. I couldn’t very well fly back to Massachusetts every time I needed to see a doctor.
Proponents of portability don’t even seem to realize that this is a problem.
Only a very few providers, like Blue Cross, are national in scope. (Nearly all American doctors take Blue Cross.) Going to portability might drive the regional HMOs like Harvard-Pilgrim out of business.
11 Cforchange // Sep 30, 2009 at 12:27 pm
Sinz, “First, ideologically they are opposed to government mandating anything”.
Really? Arent’ they really looking for a government mandate that no one should have the right to an abortion? The ideology of the party is twisted and changed depending on how the issue suits the base and that’s why we are no longer a meaningful majority.
12 sinz54 // Sep 30, 2009 at 12:36 pm
Cforchange:
They don’t see that as a “mandate,” but as a protection of the unborn baby’s Fourteenth Amendment Rights. No different from the laws we have against mothers killing their children after they’re born, or the laws against cruelty to animals.
13 balconesfault // Sep 30, 2009 at 12:41 pm
Me quoting Steve Benin “Congressional Republicans could probably save themselves a lot of trouble by simply saying, “Whatever Democrats are for, we’re against,” in response to every question.”
Sinz: Second, they don’t trust Obama, Pelosi and Reid personally. Anything that they’re in favor of, the GOP base will reflexively oppose.
Yep. That is it in a nutshell.
14 EscapeVelocity // Sep 30, 2009 at 1:12 pm
Portability – good affordable insurance not tied to employer
Get everyone or almost everyone insured – lots of people dont have insurance for multiple reasons
Medical bankrupcies – this is damaging to the economy as well as families and individuals, it should be nearly eliminated
Cost reduction – cut costs where you can
Tort Reform – Limit liability claims, which will reduce Malpractice Insurance and direct payout, but more importantly reduce ass covering as a medical practice which will significantly reduce costs of diagnosis, excessive tests and procedures
Regulation – regulate actuarial practices so that costs are averaged over larger pools, regulate insurance products as well as the market for them, encouraging competition
Existing Condition exclusion – mandate coverage, subsidize the poor, everybody is in, so system cannot be abused making the existing condition exclusion necessary
Reduce redundancy – Ditch Medicare, Medicaid, Native American Health Service, Local, State, and Government clinics and funding that serve the poor, …get everyone into the same system, to reduce costs via economies of scale
Increase competition – Ditch 50 state insurance commisioners and laws regulating insurance, provide one Federal regulatory body, increases interstate competition, aslo reduces legal costs and paperwork
Government Backed Co Ops- increases competition, keeps private sector honest (Germany does this and has 60 percent of the population in these).
Illegal Immigrants – this problem has to be tackled, else costs cannot be controlled. Furthermore, add ways to enforce the no illegal immigrants clause.
Electronic Health Records system – reduces costs, improves care
Transparency – Open records to consumers and insurers so that they can make decisions on doctors and fascilities with regards to cost effectiveness and effeciency
Licensing, encourage and allow Nurse Practicioners, especially in rural and underserved areas
Just some of many
15 Cforchange // Sep 30, 2009 at 1:57 pm
Well let me broaden my remark – worse yet they are trying to mandate the definition of life. When the base tramped into the end of life issue, that didn’t work so well – did it?
16 EscapeVelocity // Sep 30, 2009 at 2:06 pm
Well let me broaden my remark – worse yet they are trying to mandate the definition of life. When the base tramped into the end of life issue, that didn’t work so well – did it? — cforchange
Logan’s Run
http://www.youtube.com/watch?v=4WUUnc1M0TA
17 SpartacusIsNotDead // Sep 30, 2009 at 2:22 pm
Sinz,
The Federal program you reference in your third point is the PO. To my knowledge, there are no other proposals on the table that would provide an entitlement.
As for your other points, despite how deranged I believe many GOP congressmen have become, I’m still not willing to impute statements made by commenters on Redstate.com to GOP members of Congress. Much of the GOP congressional oppostion seems to be based on the cost and the potential PO.
In any event, the main thrust of my post still stands: GOP opposition to healthcare reform is not based on a belief that reform will produce results that are worse than the status quo. The opposition is purely ideological (or worse in the case of those who oppose it merely because Obama favors it) and without regard for the empirical evidence that argues in favor of strong reform with a robust PO.
18 sinz54 // Sep 30, 2009 at 2:49 pm
spartacusisnotdead:
I am sorry, you are NOT correct.
The GOP base is opposed to the Baucus bill too, even though that bill had no public option. The official stance of the GOP is to oppose it:
http://www.gop.gov/policy-news/09/09/23/if-you-like-your-current
19 SFTor1 // Sep 30, 2009 at 3:00 pm
The Republican opposition to meaningful reform is seen in the Republican discussion and proposals, which can only be described as nibbling around the edges with a view to maintaining the status quo.
If the Republicans were interested in real reform there would be proposals on the table that looked to best practices from other industrialized nations, presumably adapted to American demographics, medical services infrastructure, and geography.
There is not. Everything is said and done to protect the medical insurance industry.
20 SpartacusIsNotDead // Sep 30, 2009 at 3:38 pm
Sinz wrote: “The GOP base is opposed to the Baucus bill too, even though that bill had no public option. ”
I stand corrected. Unfortunately for the country, you are correct and the GOP prefers having state and federal governments as well as private businesses and individuals financially debilitated along with 45,000 dead Americans each year due to a lack of health insurance.
And GOPers claim to be patriots?
21 EscapeVelocity // Sep 30, 2009 at 4:08 pm
I think we should burn the Constitution and institute real change. I think that Castro has some great ideas.
22 Oh, The Health Care Posts We’ve Had And Haven’t Had And Wish We Could Do « Around The Sphere // Sep 30, 2009 at 4:37 pm
[...] David Frum at New Majority: Until now, the threat of a government-run healthcare plan has deterred Republicans from negotiations with the administration. They were (reasonably) afraid of being mousetrapped into a philosophically unacceptable deal. But if the single most threatening element of such a deal has been voted down by Democrats, the field looks different. Instead of worrying about worst-case scenarios, Republicans now can begin to think: are there things we want? Might we successfully wedge centrist Democrats away from the Chuck Schumers? Until now, Republicans have clung to the untenable healthcare status quo in great measure because they feared the likeliest alternative would be worse. But what if the alternative might be an improvement over the status quo? Suddenly the deal option begins to look a lot more interesting. [...]
23 balconesfault // Sep 30, 2009 at 4:59 pm
sinz: The GOP base is opposed to the Baucus bill too, even though that bill had no public option. The official stance of the GOP is to
oppose itoppose everythingCorrected.
24 aDude // Sep 30, 2009 at 7:57 pm
I think now is the time for the Republican Party to show leadership. With the public option off the table, we can craft a program that is based on universal coverage and cost reduction. Much of the existing plan we should embrace (no pre-existing conditions, etc), but we should go beyond that. Although it offends my Federalist soul, we should push for a plan that eliminates individual state mandates on health insurance (such as state requirements that require all policies to cover this and that condition). We should push for allowing the purchase of policies across state lines.
We should push for cost reduction through standardization. At the moment, a private physician’s office has a receptionist, two nurses, and about five people who’s sole purpose is to fight insurance red tape (which also takes several hours of the doctor’s time every day as well). We should push for some standards, so that, for example, a “bronze” plan covers only catastrophic illness, a “silver” plan covers major expenses, and a “gold” plan covers pretty much everything. Everyone would know what’s in each plan, so when the patient presents a “silver” insurance card, everyone will already know what is covered. Within each plan, the insurance companies would vary on things like the amount of the co-pay and such, but what is covered will be well known. At the same time, codes for diagnoses and treatment would be standardized (tonsillitis is always 412.12, tonsillectomy is always 709.4, etc), so the same form and the same information can be used for all insurance companies.
These things can be achieved without massive government spending, and can create significant cost savings by reducing the overhead that the current systems imposes.
And it’s a much more attractive position that always saying “no”.
25 SpartacusIsNotDead // Sep 30, 2009 at 9:23 pm
Adude,
Do you honestly think that requiring all insurance companies to use the same diagnosis and treatment codes will save enough money to compensate for the substantial expense of eliminating pre-existing conditions? There is no evidence for this.
In many rural areas there is only one insurer, which means providers only have to deal with one set of forms and codes. Yet, costs in rural districts are rising just as fast, or faster, as everywhere else. Also, Medicare already provides standardized diagnosis and treatment codes. It’s certainly helpful, but the cost savings do not come close to covering the additional expenses associated with those parts of reform that aren’t so controversial such as eliminating pre-existing conditions, removing lifetime caps on benefits and prohibiting the cancellation of insurance once it’s been issued.
All of those things have the effect of substantially increasing the costs to insurers. Standardizing codes is a good idea, but it will not produce enough savings to offset these costs.
As for the idea of buying insurance across state lines, there are a hosts of reasons why this is not very practical nor likely to produce much savings. See some of Sinz’s previous posts on this issue. Also, once you standardize the minimum requirements, those states that currently require very little coverage will experience an increase in insurance prices, and those states that require a lot of coverage will likely experience a drop in prices. On balance, the effect may not be that significant.
26 balconesfault // Sep 30, 2009 at 9:42 pm
At the moment, a private physician’s office has a receptionist, two nurses, and about five people who’s sole purpose is to fight insurance red tape (which also takes several hours of the doctor’s time every day as well).
An interesting interview I heard recently with a physician described how even though Medicare reimbursements are lower – a lot of practices prefer Medicare because they know they’ll get paid as long as they fill in the paperwork correctly … while dealing with insurance companies means interative conflicts with the companies over payment for services.
What’s odd about your plan is that in order to keep government out of healthcare – you’re willing to violate principles of federalism, basically mandate business processes for the whole industry, and institute price controls.
27 hormelmeatco // Sep 30, 2009 at 11:01 pm
There are already standardized codes, ICD-9 and soon, ICD-10.
I was very pleased when I saw that Atul Gawande’s New Yorker piece was getting some traction. I’ve been very disappointed that no one seems to have taken it’s point to heart: the way medicine is practiced needs to change. Almost every other issue related to healthcare reform is peripheral.
28 hormelmeatco // Oct 1, 2009 at 1:55 am
Correction: ICD-9/10 are for diseases. They are used in conjuction with CPT codes for billing.
29 sinz54 // Oct 1, 2009 at 10:34 am
escapevelocity:
What you have proposed for health care, is similar to the original Baucus bill. Surprise!
The original Baucus bill wasn’t bad. It didn’t add a penny to the deficit. It didn’t set America on the path to a future single-payer system. It started up regional co-ops.
The GOP still said no.
30 sinz54 // Oct 1, 2009 at 10:36 am
hormelmeatco:
I’ve been arguing that on every forum and every soapbox I can climb up on.
Nobody is listening.
Because changing how health care is practiced is going to mean that many patients will no longer get the luxurious level of care they’re used to. (At one Massachusetts hospital I stayed at, every patient–EVERY patient–gets a private room of his own. That’s absurd. It’s a hospital, not a motel.)
31 sinz54 // Oct 1, 2009 at 10:41 am
adude:
Also hospitals.
In a major Massachusetts hospital I stayed at, the doctors told me that at least 55% of their daily workload is paperwork. That’s right, they now spend more time filling out forms than they do treating patients. Everything has to be justified for the insurer. Everything has to be written down in triplicate, here, there, and over there. And from what they said, that’s typical of modern hospitals, it’s not an outlier.
32 balconesfault // Oct 1, 2009 at 10:47 am
sinz: At one Massachusetts hospital I stayed at, every patient–EVERY patient–gets a private room of his own. That’s absurd. It’s a hospital, not a motel.
True, but this is a predictable result of our current system.
Because hospitals are competing for business from people who have insurance and actually can pay bills. And if people who have insurance start complaining that they’re sharing a room, insurers will make sure they get private rooms, lest they switch policies. Because I suspect the cost differential between a policy providing for a private room, and one providing for a shared room, is not enough to get people to buy the cheaper policy. Moreover, they’re going to complain to their employers if they get stuck in a shared room, and the insurer risks losing a big account. Better just to not rock the boat.
The free market comes to the best short term commercial solution – and not the best solution from a resource allocation basis. Useful in many ways to help stimulate creativity and innovation, but it has its limitations.
33 balconesfault // Oct 1, 2009 at 10:50 am
And that’s because insurance companies best opportunity for increasing profits is to stiff the providers. Thus, on the other side of the fence, there is a substantial bureaucracy tasked not with facilitating payment, but with denying claims.
The natural product, once again, of a free market system. Once again, as someone who is a big free market advocate in general, I have to ask if the healthcare system is best left in the hands of the free market?
34 balconesfault // Oct 1, 2009 at 10:51 am
urgh – let’s try that again (an edit function would be SO nice!):
Sinz: In a major Massachusetts hospital I stayed at, the doctors told me that at least 55% of their daily workload is paperwork. That’s right, they now spend more time filling out forms than they do treating patients. Everything has to be justified for the insurer. Everything has to be written down in triplicate, here, there, and over there. And from what they said, that’s typical of modern hospitals, it’s not an outlier.
And that’s because insurance companies best opportunity for increasing profits is to stiff the providers. Thus, on the other side of the fence, there is a substantial bureaucracy tasked not with facilitating payment, but with denying claims.
The natural product, once again, of a free market system. Once again, as someone who is a big free market advocate in general, I have to ask if the healthcare system is best left in the hands of the free market?
35 SFTor1 // Oct 1, 2009 at 1:43 pm
The problems with our current health care system are plain to see. Possible solutions are not hard to imagine. Yet nothing is done in Washington.
This must be the ultimate showcase for why corporate money must be banned from politics. Yes, yes, union money too.
36 EscapeVelocity // Oct 1, 2009 at 2:23 pm
I think Racist money from groups like La Raza and NAACP should be banned as well.
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