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Health Reform: GOP Must Offer More than “No”

December 14th, 2009 at 1:19 pm | 25 Comments |

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So far the entire Republican position on healthcare has seemed to be reflexive opposition to whatever the Democrats are doing – and not just opposition, treat but opposition from the left! Basically, sovaldi sale just scaring the seniors with the prospect of Medicare cuts (especially in the area of hugely expensive futile care in the last days of a person’s life) and spreading feminist propaganda (“women-focused cancers are seemingly receiving substandard attention” – yep, doctor that’s Sarah Palin, not Gloria Steinem: ). But what does the GOP actually have to offer?

Normally, of course, conservatives defend the status quo. But the status quo is indefensible! And it’s only going to get worse. Medical costs are growing fast and will continue to grow (as people live longer while using more of the new wonderful – and expensive! – treatments), the number of people with chronic conditions is growing and their costs are skyrocketing, and in the meantime genetic tests, other medical tests, mathematical models (my professional subject) and other methods allow us to predict individual risks more and more accurately.

We keep hearing that we should maintain our conservative principles. But what exactly do our principles require us to do on healthcare? Let’s consider a hypothetical situation which is going to happen more and more often in coming years. Suppose, prenatal genetic tests show that while the child is likely to be born healthy, adulthood is going to be a different story – the individual is very likely to develop some incurable chronic condition at a relatively young age. Suppose further that the condition is quite debilitating if untreated, but can be easily managed (allowing the patient to lead a virtually normal life), albeit not cheaply – say, at the cost of $2,000 a month. Suppose finally that the same tests also show that the individual will probably have mediocre cognitive, artistic, athletic and other abilities and thus will be unlikely to earn more than, say, $3,000 a month. What exactly can we suggest without violating our principles? Obviously, abortion would be a grave violation of our pro-life principles, and I hope that even pro-choicers would be appalled by such a Spartan-style “solution”. If the parents have a modest income and other children, they are not going to be able to leave enough money to provide for that child lifetime’s healthcare. That individual will be able to save only very little before the onset of the disease, and afterwards pay as you go will be just unaffordable (while not getting treatment will be just as unaffordable since in that case the individual will not only suffer, but also will be unable to work and earn a living!). So what’s that individual to do? Meticulously maintain health insurance since the early age in order to circumvent restrictions on pre-existing conditions? But a disease triggering gene variant is in itself a pre-existing condition! In a truly free market insurance companies will, of course, be aware of known risks and will price them into the premiums. Denying health insurers access to medical records is akin to denying auto insurers access to driving records or denying lenders access to credit histories (yes, there’s a moral difference, since unlike genetic composition, driving record and credit history are based on behavior – but what matters in a free market is risk assessment, not blame assignment). Mandating some form of “community pricing” (i.e. ordering insurance companies to disregard individual risks) may be a solution (although young people with “healthy” genes will quickly figure out that their premiums are absolutely not commensurate with their risks and will then be hesitant to buy insurance), but it’s definitely not a free market solution – it’s the government clandestinely forcing some people to pay for other people. A more honest thing would be for the government to tax people openly and spend money on treatments for those who can’t afford them. But that would mean creating new government programs or expanding the existing ones (while probably raising taxes!), and conservatives can’t stand for that, right? (just ask the Club for Growth!)

So, what are we to do with that hypothetical individual? The only thing I can think of that does not violate any conservative principles articulated by various conservative spokesmen over the past couple of years is to do nothing (as far as the government is concerned) and hope that some private charity will pick up the tab. This approach might actually work (and in an ideal world I would in fact prefer it). But the inconvenient (for the purists) fact is that in the here and now we have to sell this (or any other) approach to the majority of voters. I’m afraid that as the number of people struggling with expensive chronic conditions grows, the “let them beg” answer is not only going to be unacceptable to a significant number of independents, but also even to significant segments of the Republican base, such as many evangelicals who are primarily motivated by social conservatism but are not very keen on free markets and are in fact quite sympathetic to “compassionate conservatism” (Exhibit A: Mike Huckabee). And, of course, if Republicans don’t offer convincing answers, the voters will turn to the Democrats.

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25 Comments so far ↓

  • CentristNYer

    I think you’ve done a good job of assessing the serious risks for the GOP in defending the status quo, which, whether they admit or not, is what their strategy is doing. The reform of a health care system that leaves ordinary people bankrupted by obscene costs — or dead because they couldn’t afford treatment — is not something Republicans want to be seen as obstructing.

  • Demosthenes

    You live in Bizarro World, where the Republicans actually wanted to act responsbility on behalfo the public interest. Here in the Real World, the Republicans only care about partisan politics, and just want to crush the Democrats. The remember 1994, when the voters punished the Democrats for failing to pass HCR, and this is the goal for the Republicans. The public be damned.

  • Demosthenes

    You live in Bizarro World, where the Republicans actually wanted to act responsbility on behalf of the public interest. Here in the Real World, the Republicans only care about partisan politics, and just want to crush the Democrats. They remember 1994, when the voters punished the Democrats for failing to pass HCR, and this is the goal for the Republicans. The public be damned. [TYPOS CORRECTED. SORRY]

  • franco 2

    Tort reform, insurance portability and yes charity.

    Health care really isn’t the place for government intervention.

    Those trained and/or interested in public policy share certain assumptions due to the nature of their interests, and seek to solve problems from a hierarchical perspective. That is, they want to design policies for the rest of us and they naturally want to make it “fair” for everyone. Problem is, nothing can be made fair unless EVERYTHING is made fair. This is the path to leftism and totalitarianism.

    Free markets are the best solutions. The harder you work the better health care you can get. The more you contribute the better health care you get. The more open markets are the better health care is available for all. And the best fall back position for a society? Charity.

  • sinz54

    The GOP did have a solution:

    Here in Massachusetts where I live, Governor Mitt Romney was pushing for universal coverage for all MA citizens even before the Dem legislature picked up the ball.

    And he achieved it–without a single-payer system, and with substantial private sector involvement. A subsidized public plan is available for the truly needy–it’s means tested, so the affluent don’t qualify for it. Hence it cannot compete with private insurers for the affluent consumer.

    How did he do it? By deliberately punting on strict cost controls until after he could get buy-in from all the stakeholders. Only now is the MA legislature wrestling with cost controls.

    The GOP could have used RomneyCare as a role model. But too many of them think like “franco 2″: If you can’t get coverage, go begging to churches and charities. Or, if that fails, you can always go shuffling down a bus or subway car with a tin cup in your hand.

    As a result, when Romney ran for President in 2008, he had to run away from his signature achievement. Too bad. I could have envisioned him debating Obama: “I enacted universal coverage. Where’s yours?”

  • sinz54

    The cloud of genetic abnormalities has a silver lining: Knowing what diseases you’re susceptible to, will make you extra careful to head them off.

    Already, some women with identified genetic predispositions to breast cancer are choosing pre-emptive mastectomies rather than wait for the cancer to show up.

    Someone with a genetic predisposition to lung disease will resolve not to smoke. Etc.

    And that may increase life expectancy. (Though it probably won’t lower health care costs too much–no matter how many diseases you dodge, some disease is going to get you eventually.)

    As for what to do about genetic birth defects: The obvious free-market solution is a kind of “procreation insurance policy,” in which prospective parents take out a policy with an insurer to insure them against the risk of a genetically damaged child. Then they go procreate. If the child has Down’s Syndrome or a genetic predisposition to childhood cancer, the policy pays off on the claim.

  • rbottoms

    The only thing I can think of that does not violate any conservative principles articulated by various conservative spokesmen over the past couple of years is to do nothing (as far as the government is concerned) and hope that some private charity will pick up the tab. This approach might actually work (and in an ideal world I would in fact prefer it).

    And this is why the Republican party is the party of jerks. What person with some semblance of a soul could even write such a thing. Anyway, sentiments such as the author’s are the Democrats and going to beat the GOP come 2012 and beyond.

  • satkinsn

    ” Problem is, nothing can be made fair unless EVERYTHING is made fair. This is the path to leftism and totalitarianism.”

    I think the exact opposite is true – we can (and do) pick and choose what’s ‘fair.’ Example: in my small town, we all get basically the same police protection. There may be individual likes or dislikes among members of the force, but in general a murder in a poor neighborhood gets handled like a murder in a wealthy neighborhood.

    On the other hand, our local school district offers assorted enriched and accelerated classes to students who are picked on not much more than teacher recommendations. It’s a system that many people believe is ‘unfair,’ but it survives because it has a constantly replenished supply of constituents – the parents of the ‘gifted’ kids.

    ” The more open markets are the better health care is available for all.”

    I agree with the sentiment, but it’s a lot more complicated than that, HMOs being a good example. They were supposed to hold down costs by encouraging competition between doctors and other medical providers. (i.e. – If you, Doctor ‘A’ didn’t take what I was offering to treat a cold, Doctor ‘B’ will. Do that often enough on a big enough scale and you’ve got real savings.)

    What was ignored or underplayed was the behavior of the HMOs/insurance companies themselves as rent seekers. I don’t think it’s unreasonable to say that what they saved at one end was spent (largely) at the other.

    On the article itself: the only thing that will stand against the wave of knowledge about to be uncorked in the medical field is a strong set of traditions and customs – “even though it’s a loser, we treat this person with this awful ailment.” The wealth transfer will be disguised in those customs, as such things often are.

    s.

  • rbottoms

    Problem is, nothing can be made fair unless EVERYTHING is made fair.

    Horse Hockey. That’s not our position at all, and is only an excuse for the selfish to do nothing. I got mine, you — go beg in the street and maybe someone will help you.

  • sdspringy

    What Crap, anytime someone has to invent three hypothetical situations to prove an argument the argument stinks.

    And to start with the “what ifs in the coming years” is a completely fraudulent. Maybe we will fix genetic problems in the womb, problem solved. End of stupid argument.

    As it stands now fiscal healthcare reform hinges on the Politicians cutting Medicare. Show me once were that is going to happen.
    Currently anyone below a certain income level in eligible for Medicaid and all children are covered under SCHIP.

    And I am really tired of Sinz54 pushing Mass healthcare which is bankrupting the state. Great solution, drive everyone into the poor house. Everyone is the same then, except for the rich and politicians, great plan.

  • PracticalGirl

    Here’s a list of the 92 amendments (as of about a week ago) that have been put forth by all the politicians. View and judge for yourself.

    http://openleft.com/diary/16327/all-91-senate-health-care-amendments

    Demosthenes makes the point- The GOP never has, doesn’t now, and never will support real health care reform. They obstructed their own ability to have any meaningful impact when they chose to rattle on about “death panels” and support the Tea Partiers (whose ONLY message is NO!) and when they led their faithful into a bumpersticker chant about socialism.

    Forget the insurance debate…True cost containment reforms will always include a component about reasonable expectations of the covered group. That includes palliative care, hospice environment vs agressive, futile treatment for those at the end of their lives. When we get to issues like this (and we have) ignorant and loud talk show hosts (even those who previously supported hospice) rile their base that the government is trying to kill them. And the GOP politicians, who smell a popular argument for “NO!” follow suit.

    Another cost containment issue with real merit (and real savings) that has been gingerly brought up before and shot down by the fearmongerers that run the GOP: Something simple, like the idea of funding home health nurses for pain managment and other things that could easily and much more cheaply be handled in a home environment rather than a hospital. What happens, though, when the issue is brought up? Inevitably, GOPers and their followers turn away from reasonable cost containment measures inherent and scream that THEY’RE TRYING TO KICK US OUT OF THE HOSPITALS!!! and so on.

  • PracticalGirl

    Franco 2 puts forth the tired

    “Tort reform, insurance portability and yes charity. Health care really isn’t the place for government intervention.”

    What a crock…I guess you’ll be foregoing your own Medicare, then?

    Tort reform has been PROVEN not to decrease any cost but that of the lobby group which it is intended to benefit. In state after state. Take Texas-and Conservatives in general-who CROWED when it enacted its own tort reform. And why not? Doctors flooded the state, and their malpractice costs decreased by just over 42% almost immediately. Yippee! Only, something happened on the way to consumer prospertiy…They didn’t share in it. Health insurance costs continued to increase-7 times faster than income- and health care costs did not go down appreciably. The interesting thing is that Texas also capped non-economic damages to 1.2 million, no matter the damage. This means that a 36 year old specialist (maybe one who fled to Texas) who is permanently damaged- or killed-by medical malfeasance could only expect compensation for about 6 years of lost income. Hmmm…

    Portability is fine, but the whole “crossing state lines to purchase” mantra is a dead stick with physicians and provider groups. Why? Because they struggle to keep up with the 5-10 plans (and all their codes and paperwork) in their state as it is. What happens when they have to satisfy 50, 100, 200 different plans? They start hiring a lot of claims specialists, and your costs go up.

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  • franco 2

    satkinsn,

    I think the exact opposite is true – we can (and do) pick and choose what’s ‘fair.’ Example: in my small town, we all get basically the same police protection.

    I’m noticing you use your “small town” as an example. We are talking about a diverse country with hundreds of millions. Do you really think the people of Detroit get the same police protection as the people in Beverly Hills? And don’t you think, in order to achieve the same level of protection, that many, many other things would need to be dealt with to bring this kind of equality if it were possible at all?

    The smaller the group, the better communism works.

  • franco 2

    Clarification of above post 14 (sorry)

    satkinsn says:

    “I think the exact opposite is true – we can (and do) pick and choose what’s ‘fair.’ Example: in my small town, we all get basically the same police protection.”

    Franco says:

    I’m noticing you use your “small town” as an example. We are talking about a diverse country with hundreds of millions. Do you really think the people of Detroit get the same police protection as the people in Beverly Hills? And don’t you think, in order to achieve the same level of protection, that many, many other things would need to be dealt with to bring this kind of equality if it were possible at all?

    The smaller the group, the better communism works.

  • MI-GOPer

    It’s amazing to me that after all these long years of debate over holding down medical cost increases or making health care insurance more affordable to more people or simple reforms of the most onerous “cancers” growing in our health care system, the Democrats and far Left still trot out the canard: “Republicans ain’t got no plan for reform”.

    Only a deaf, blind, dumb democrat or leftie could propose such nonsense and expect anyone outside their echo chamber to believe them.

    I think that’s why American voters (no, not ACORN wannabe voters) have shifted and a majority see the GOP as having the best ideas on medical insurance and cost controls. The one item that is missing from the list others have put forward on GOP Health Care Reform is Sen Alexander’s proposal to provide catastrophic medical coverage for the uninsured.

    Hardly a canard of Just Saying No. That approach might have worked for drugs and sex… well, except for Clinton, Spitzer, Edwards, Kennedy… oh well.

  • satkinsn

    “The smaller the group, the better communism works.”

    I know it doesn’t go to heart of your post, but I gotta argue with this in passing. First, communism is dirt stupid (among other things) and it doesn’t work *anywhere.* But if we pretend to take it seriously for a minute, small groups are the worst place for communism, because the many problems of it can’t be hidden by transferring those problems out of sight.

    On to the rest:

    “Do you really think the people of Detroit get the same police protection as the people in Beverly Hills? And don’t you think, in order to achieve the same level of protection, that many, many other things would need to be dealt with to bring this kind of equality if it were possible at all?”

    The point here isn’t to be perfect, or perfectly fair. Government – and for that matter, free markets – is a blunt instrument. If Republicans decide to move past ‘no,’ (to take the author’s thesis) they just have to do better. In my view, you can stand a long way from theoretical perfection and still make the system better.

    Scott A.

  • sinz54

    MI-GOPer: It’s amazing to me that … Democrats and far Left still trot out the canard: “Republicans ain’t got no plan for reform”
    The charge is accurate–once we define the term “reform.”

    What “health care reform” means to both Dems and to most Americans is guaranteed access–no American with a catastrophic chronic illness (cancer, kidney failure, Alzheimer’s, etc.) will ever be denied whatever care they need to treat their disease properly. (And no, you CANNOT get continuing treatment for such chronic illnesses in Emergency Rooms. Try getting a kidney transplant via an Emergency Room.)

    What “health care reform” means to most Republicans is cost containment–that those companies and individuals who already have generous insurance plans will not be bankrupted by skyrocketing increases in their premiums. But that does nothing to increase access to health care by those who need it. There are plenty of people who cannot get health insurance at all because of their pre-existing conditions. There are former policyholders whose coverage was canceled due to any excuse the insurer could invent. Yet the most hard-core conservatives, like Levin at National Review, assert that government can’t interfere with that.

    Americans care about cost containment too. But they care more about getting health care before they care about the cost of it. How do we know? Because almost no one will turn down the care they need to cure their illness, just because it may cost a lot of money.

    So I think it’s safe to say that most of my fellow conservatives just don’t care about increasing access. They care only about holding down the costs of those who are already generously insured.

  • balconesfault

    Sinz: So I think it’s safe to say that most of my fellow conservatives just don’t care about increasing access. They care only about holding down the costs of those who are already generously insured.

    One could say, Sinz, that this is what makes them conservatives.

    With your goal of increasing access … perhaps the question is whether you should be using the term “fellow conservatives” when you discuss this particular issue.

  • satkinsn

    “Sinz: So I think it’s safe to say that most of my fellow conservatives just don’t care about increasing access. They care only about holding down the costs of those who are already generously insured.

    balconesfault: One could say, Sinz, that this is what makes them conservatives.

    With your goal of increasing access … perhaps the question is whether you should be using the term “fellow conservatives” when you discuss this particular issue.”

    Nah. It’s just fine to worry about costs without it being a case of “we’ve got ours, Jack.” Besides, the two issues are bound together – you’re not gonna be able to insure more people without dealing with cost. And while you’re right, I don’t care what it costs when I’m bleeding, that’s hardly the standard for making a sensible decision about how we’re gonna do things.

    Scott A.

  • balconesfault

    Scott – I’m not sure where you’re coming from here.

    From listening to the conservative commentators here, it seems any expansion of coverage that requires federal subsidy is essentially a liberal idea.

    You can be conservative and favor expanding coverage via charity.

    You can be conservative and favor cost control … with the proviso that cost control on the government-provided healthcare side should be used as a tool to reduce taxpayer burden, and not as a means to free up money to be used for expanding coverage – ie, further expanding the reach of the federal government into providing healthcare.

    And cost-control on the private side is a pathway to expanding healthcare via making healthcare more affordable via free-market mechanisms, and not by making it less expensive for government to cover more people.

    The real ideological debate here is whether “increasing access” is really achievable without government playing a significant role in directly helping many afford healthcare.

  • garlic

    For the backup plan for the poor to be charity, a lot of money would have to be given to the charities that fund their healthcare. Is there a nationwide US charity that deals with the health of the poor?

  • balconesfault

    the backup plan being charity also has to deal with the reality that recessions tend to cause both severe slumps in charitable donations … and marked increases in the number of people needing charity

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