A familiar narrative has emerged on the Republicans’ prospects for slowing down the coming Democratic health care proposal.
In short, we’re not in 1993 anymore, and the GOP is in trouble.
In 1993, Republicans triumphed over Clintoncare with the support of insurers and their advertising dollars. Today, however, insurers, doctors and drug-makers are supportive of reform. The business community, the unions, and interest groups are all holding hands and standing with the President. And until some of those stakeholders jump ship, the Republicans are sunk.
Republicans seem to have internalized this story. They believe they are done-for unless industry gets on their side, as it did in 1993.
It is time for Republicans to set this story aside.
The fact is, Republicans have a real opportunity to derail Democrats’ efforts, and the model is their 2007 defeat of immigration reform.
In 2007 the stars were aligned for immigration reform. The business community supported it because it provided cheap labor. The unions supported it because it promised increased dues and new voters. The President supported a bill. The Senate Democratic leadership supported a bill.
And yet it was defeated with two populist arguments on behalf of the middle class. First, the proposed reform would further undercut middle class prosperity. Poor immigrants and the business community would benefit, as would an upper class dependent on the services provided by immigrants. Yet the middle class would wind up holding the bag, paying for increased crime and social services, the consequences of expanding the ranks of a poor and unskilled workforce. While pitched as a matter of simple justice, this reform effort was actually driven by politicians seeking electoral advantage and groups promoting narrow economic interests.
Second, if politicians were truly interested in addressing mass illegal immigration, they should do so through a two-step process – enforcement before amnesty.
Against the odds, this bill was defeated when congressional Republicans and their few Democratic allies, with the help of talk radio and cable television, made a strong populist case against the interest groups, businesses, unions, and politicians advancing this legislation at the expense of the middle class.
Conservatives should return to this playbook as they prepare for the coming fight over health care.
As with immigration, the stars are aligned in favor of health care reform. Business and the unions are supportive of efforts by the President and Congressional majorities. And while publicly promoting a modest and just end – universal coverage and decreased costs – these stakeholders are in fact prepared to cut a deal that will serve their own bottom-line to the detriment of middle class families. While pitched as a moderate reform, the Democrats’ creation of a government option will lead businesses to drop coverage for millions of middle class employees who are relatively happy with their health care. Those individuals will then be forced into a system where coverage and care are dictated by a government bureaucracy. For the privilege of this decrease in quality, the middle class will eventually pay more in taxes. And meanwhile, the truly wealthy will retain their ability to pay extra for any health care needs they have.
The President will no doubt speak of the need for shared responsibility to expand coverage, but Republicans need to reject a hasty reform cooked up among interest groups and politicians that will unduly burden middle class Americans.
And just as they argued “enforcement first” with immigration, the GOP can argue that government must control health care spending before creating any new entitlements to health coverage. At one point the President promised to prioritize reductions in costs over expanded coverage. But to date, negotiations on the Hill have been almost exclusively on the design of a public option, while the President promotes empty promises of future savings. Unless this changes, the middle class will inevitably be forced into a health care system for which it will pay more and receive inferior care.
A country already weary of bailouts and excess spending on behalf of wealthy interest groups at the expense of those who actually pay their bills will likely be open to a populist appeal on behalf of fiscal responsibility and middle class prosperity. Republicans need to stop waiting for a rerun of 1993. The example of 2007 should demonstrate that when it stands with the middle class, the GOP can succeed even without business allies.
28 responses so far
1 barker13 // May 22, 2009 at 8:45 am
“[Big] Business and the unions are supportive of efforts by the President and Congressional majorities. And while publicly promoting a modest and just end universal coverage and decreased costs these stakeholders are in fact prepared to cut a deal that will serve their own bottom-line to the detriment of middle class families. While pitched as a moderate reform, the Democrats creation of a government option will lead businesses to drop coverage for millions of middle class employees who are relatively happy with their health care. Those individuals will then be forced into a system where coverage and care are dictated by a government bureaucracy. For the privilege of this decrease in quality, the middle class will eventually pay more in taxes. And meanwhile, the truly wealthy will retain their ability to pay extra for any health care needs they have.”
Yep. I concur.
“A country already weary of bailouts and excess spending on behalf of wealthy interest groups at the expense of those who actually pay their bills will likely be open to a populist appeal on behalf of fiscal responsibility and middle class prosperity.”
Agreed.
BILL
2 midcon // May 22, 2009 at 8:59 am
Succinctly put. You’ve managed to encapsulate the entire GOP strategy — ‘Republicans have a real opportunity to derail Democrats efforts, and the model is their 2007 defeat of immigration reform.’
Yep, that’s party of ideas all right. Now that Rush has resigned maybe you could take his place.
Your and the GOP’s solution to immigration is to round up 12,000.000 illegal men, women and children and then deport them? Or to put the children of deportees into forster homes (because many are U.S. citizens). Have you completed the business case analysis (BCA) to understand what the cost would be and whether or not that would even be executable?
What box of cereal did you get that from? The GOP is hovering around 21/22 % and that’s the best you and the rest of the GOP can come up with?
Nearly every single day you and many of rest of the GOP make me thank God that I had the sense to leave the party so that I don’t have to suffer the embarrassment of this drivel.
And please change your bio. I am tired of trying to convince people that civil servants (feds) are intelligent and that it’s Congress that’s the problem just to have feds like you make their argument for them.
3 sinz54 // May 22, 2009 at 9:16 am
The author sez: “Republicans have a real opportunity to derail Democrats efforts, and the model is their 2007 defeat of immigration reform.”
That’s a strange “model.” It left America with no immigration reform at all, opening the door to Obama to push an immigration reform bill through his filibuster-proof Senate which is much further to the left than the one the GOP base defeated.
And BTW, it was the GOP *base* (and many Independent voters too) who led the revolt against immigration reform, not the GOP leadership, which generally was behind it.
How can “a populist appeal on behalf of fiscal responsibility and middle class prosperity” appeal to voters, if they know it means living with the current system for the indefinite future, with its denials of coverage for pre-existing conditions, its disparities for group vs. individual coverage, etc? How does the current system provide for “middle class prosperity”?
4 LeeHotchkiss // May 22, 2009 at 9:29 am
The problem with this analogy is that most of the self interest argument is hogwash. Middle class workers don’t compete with illegal aliens. They compete with Indians who can work for much less than even an illegal alien in a tent could work for.
Illegal labour in the United States is only cheaper because it is illegal. If the workers were legal they could promise to work for less than minimum wage or under illegal working conditions and then break that promise latter.
As soon as illegal aliens are made legal all the advantage of hiring them goes away. Thus by continuing the system of immigration we currently have workers have continued downward pressure on wages and working conditions.
The reason immigration reform failed was not economic it was social. The reality is that health insurance began as an insurance against financial ruin more than to guarantee treatment.
Now a serious illness almost always ends in bankruptcy for middle class taxpayers.
I can”t describe the terror of not having health insurance. The toll of losing your money your credit and now more and more even access to work which is often also tied to credit ratings.
The health care system in the US is really broken. There isn’t the cultural issues to obscure things. The American people aren’t going to accept the status forever. If the Republicans want to stop Obama care than they better come up with something that removes the terror experienced by the recently middle class who are running out of their cobra or can’t afford it.
5 liv&win // May 22, 2009 at 10:32 am
I agree that this is a terrible analogy. Even worse, derailing their efforts without a remarkable alternative is a huge mistake. And we still are not clear on what we are trying to accomplish. Health Care is not Health Insurance. Health care is a service provided by a medical professional to a patient. Health insurance is a method to finance the cost of health care. The only thing wrong with our health care is that it costs too much. Nearly all the problems we have are the result of this.
Lee, the problems you sight are health insurance problems and can be easily legislated away. If something can be easily changed, it can’t be really broken.
If what we want is reasonable access to quality health care at an affordable price, then we can build that system. But COST HAS TO COME DOWN. And no one’s proposals are dealing with cost. the republicans think that competition will magically reduce costs. the problem is that alot of health care is not optional and is urgent. this is the hallmark of inelastic demand and as a category of services, they do not work in a normal supply demand equation.
It is because of COST that health insurance is expensive even when it excludes pre-exisiting conditions. So we need to drill into why, why does health care cost so much? Malpractice, education, administration, new technology, increased demand, inflation…Address these issues and you can affect the cost of the care being provided.
Having studied this issue for 10 years I have concluded that there is no silver bullet and that every solution I have reviewed either adversely affected access or quality and none have an effect on cost. And as I have said before here, no proposal links mental oral or occular health with physical health care. I suspect the best solution is one that includes a level of universal coverage (primary care) with individual choice/insurance (secondary coverage). What the republicans need to do is drive the debate home, literally. All health care is local and should be managed and organized locally. If you look in your region, you will realize that all the pieces are there, great doctors, clinics, hospitals, labs etc. The people recieving the service should have the most input about how those services are delivered, to whom and for how much.
The thing is this, that medicine is not a good industry for free market competition solutions. Health insurance on the other hand is. Also, the relationship between a patient and provider of health care services is wonderfully symbiotic. patients need and want providers and providers need and want patients. We know what patients want (reasonable access to quality health care at an affordable price). What do doctors want/need to be able to provide us with that? Organize locally and ask the question. What if we agreed not to sue you doc, could your malpractice insurance costs be reduced? How can you work with us to assure quality and compensation? What’s that, change the system so bad doctors get identified easily and booted from the profession fairly and appropriately? I like that. Next item.
6 Henry Clay // May 22, 2009 at 11:06 am
Thanks for the comments…a few thoughts.
As a general matter, I agree with all of you that it would be a mistake for the GOP to offer no proposal for health care reform because there is a good deal of middle class anxiety over health care, even among those with decent health care. I would argue, however, that the cure that the Democrats seem to be advancing would ultimately leave the middle class worse off than it currently is.
Sinz54: I agree with you that the status quo is unacceptable. Given more space there is a companion point that I would have made here….the GOP makes a mistake in arguing simply that “America has the best health care system in the world and the Democrats are attempting to kill it.” While most Americans do have health insurance and access to excellent care (the side of the coin I was emphasizing here), it is also the case that the current system is a mess.
LeeHotchkiss: I did not intend to discount the experience you are describing. Your account of the “terror” of not having health insurance is something that Republicans dismiss at their peril.
liv&win: I have not read your previous comments on oral, mental, occular health and the relationship to overall health and costs. I would be interested in reading them if you were to repost them. As someone who has studied this issue extensively, would you agree that at least a certain, not insignificant, percentage of health care is optional. Wouldn’t targeting that unnecessary treatment through market incentives be a good place to start dealing with health care inflation?
midcon: I have never indicated in any post at New Majority that I support the mass deportation of 12 million individuals. I haven’t because I don’t. Not quite sure how you reached the conclusion based on this post that I want to “round up” these people, but your conclusion is mistaken.
7 liv&win // May 22, 2009 at 12:14 pm
“would you agree that at least a certain, not insignificant, percentage of health care is optional. Wouldn’t targeting that unnecessary treatment through market incentives be a good place to start dealing with health care inflation?”
How does one know if it is or not? If you live or die? Personally, when there is a doubt, I call the nurseline and talk through what is going on inorder to decide if I need to see the doctor. It’s electronic triage.
I think my larger point is that market incentives are poor levers which can move health care to do x or y, but inefficiently. How do you effectively and accurately apply market incentives? I am sure there are some clever ideas, but I prefer simple, especially when we are talking about humans and their health.
If I were to agree with you, I would also note that most of those unnecessary health care services are also mostly found in primary settings. This is a logical assumption on my part. The most frequent procedures are routine/primary care and it would seem logical that if any of them are unnecessary, they would make up a not insignificant percentage of all health care treatment. So are unnecessary treatments a marketplace problem or a delivery/medical management problem?
It is both…
8 liv&win // May 22, 2009 at 12:20 pm
Both in that unncessary procedures also fall into the “defensive medicine” category. Tests and procedures which help a doctor document his defense against a malpractice suit. But it is also a delivery/medical management problem because the doctor has limited time/resource to deploy in a finite period of time. Treating all patients the same and giving first come first serve priority rather than triaging them is also a wasteful practice. It adds suffering to those already suffering and provide no benefit to the line cloggers as they have no benefit to gain other than peace of mind.
Interestingly, how to you give someone peace of mind? Mental health practitioners can deflect some of this from the medical doctor.
9 // May 22, 2009 at 12:25 pm
“[T]he Democrats creation of a government option will lead businesses to drop coverage for millions of middle class employees who are relatively happy with their health care.”
Does the author not realize that businesses have been dropping employee coverage in greater and greater numbers, and that tens of thousands of middle-class jobs have been moved offshore, in significant part, b/c of healthcare costs? Moreover, the jobs that remain onshore are now filled w/ employees who fear the eventual loss of their jobs.
Assuming this statement is accurate (which is far from certain), I’ve never understood why “pro-business” Republicans would not want to free American businesses from the cost of employee healthcare. From a purely economic perspective, you would be very hard-pressed to think of a more pro-growth strategy than a plan that frees businesses from those costs, while at the same time, results in a much healthier national workforce.
Additionally, you would decrease the number of personal bankruptcies by more than half.
Please tell me what is the benefit in opposing this kind of reform.
10 // May 22, 2009 at 12:38 pm
liv&win said: “every solution I have reviewed either adversely affected access or quality and none have an effect on cost.”
I don’t know what solutions you’ve reviewed or how extensive your review was, but there are certainly healthcare systems that do a much, much better job at containing costs. Practically every other system in the industrialized world does a much better job at containing costs than the U.S. system.
And, as for acess and quality, France, Singapore, Japan and the Netherlands all provide universal access while, at the same time, providing care that is comparable to that in that in the U.S.
Does the U.S. have the absolute best hospitals and technology? Almost certainly so, but keep in mind that the best hospitals and technology are not available to the overwhelming majority of Americans, irrespective of whether or not they have insurance.
11 // May 22, 2009 at 1:08 pm
Mr. Clay and many other conservatives argue that a public option will result in the eventual disappearance of private coverage. There is absolutely no evidence whatsoever that this will occur. There is, however, compelling evidence and experience to show that private and public plans can co-exist and compete in the insurance marketplace.
The largest workers comp insurance market in the country is, and has been for many, many years, comprised or a public plan and private insurers.
Additionally, the Singaporean healthcare system is comprised of a public plan alongside private insurers.
And, although not a true public-private solution, Medicare itself offers the option for the elderly to bypass insurers and purchase services directly from a healthcare provider or, alternatively, enroll in a private insurance plan, which will pay the provider for services rendered to the patient.
Mr. Clay, if your intent is to inform the reader and stimulate healthy debate it would be helpful if you were less partisan and more informed.
12 sinz54 // May 22, 2009 at 1:16 pm
Spartacus: Republicans *do* want to free businesses from the cost of providing health care. But they want to do it by making employees responsible for purchasing their own individual coverage, by giving them the same tax breaks that the employers get for providing group coverage. And by making those individual coverages portable, so the employee takes his coverage with him from job to job, just like he takes his automobile insurance.
That plan has some serious flaws: It doesn’t fix the pre-existing condition constraint; it doesn’t provide health care coverage to the poor who simply cannot afford to pay any premiums; and it doesn’t deal with managed-care type coverage where the network of providers (doctors and hospitals) is local to one area, making portability impossible. But it would free businesses from providing health care to their employees.
13 liv&win // May 22, 2009 at 1:18 pm
Spartacus, the solutions I have studied are reforms to the US system, and I have not deeply reviewed health care systems in other countries. We are just too structurally different to bother too much with adopting other systems. Interestingly, while we have spent tons of money and have arguably the best quality, we’ve made our capital improvements and I think it is time to redeploy those in a more efficient manner.
As for “From a purely economic perspective, you would be very hard-pressed to think of a more pro-growth strategy than a plan that frees businesses from those costs, while at the same time, results in a much healthier national workforce”, I am still confused at to what you expect to happen to the costs we are now paying? Do you expect they disappear? Business will pay less in insurance premiums and business taxes will increase to compensate. One thing is for certain, if a business thnks the ins co is ripping them off, the business finds another ins co. Good luck doing that with politicians, govt and taxes.
Back to access, quality and cost…Obama’s health care proposal thus far has neglected cost as the major issue, which it is. Please don’t try to tell me the uninsured is the problem because it is not. 25% of the uninsured are eligible for current public programs and don’t enroll. 50% of the uninsured don’t buy it because either they don’t think they need it (young men age 18-25) or can’t afford it (there is that cost thing). That leaves 25% with a problem and those problems can be easily legislated away. Obama cleverly has left cost out of his proposal because he knows the facts. The fact is that despite cost control, health care entitlements are bankrupt and the only way to reduce costs in his solution is to restrict access. I don’t necessarily disagree. End of life issues are IMHO often very wasteful and non-beneficial. But without having that conversation, in detail, over time, with the entire country is tantamount to living under a dictator. It is our health we are talking about, not a government program. Who/which is the slave and who/which is the master?
14 liv&win // May 22, 2009 at 1:28 pm
Sinz54: Again, please…health care is not health insurance! Your portability comment is a lark. What do you want to do, have your doctor move with you? If you want to talk about health insurance, easy. I can fix that for you right now. No more pre-ex limits, no more denial of application. Now you have insurance which is “portable”. But health insurance is not the fundamental problem. the cost of health care is THE fundamental problem. the main question regarding health care is how do you reduce cost without affecting quality and access? In its current iteration you can’t. ANd please don’t downplay cost shifting as a major cost driver for private plans and the impact on access and quality if everyone went to a public plan.
15 Bulldoglover100 // May 22, 2009 at 2:14 pm
It’s time for our party to realize that elections have concequences. We lost and we lost so big that just the thought of coming up with a message that is believable is going to be a tough road to hoe without this diatribe.
Obama will get his health care. Period. he ran on that platform and he was elected by a majority of people in this country on that platform….and now you want us to fight a fight that we cannot win????for principle? when we could be spending this time coming together and working through where we went wrong?
There comes a point when it’s best to NOT keep fighting when your out of ammo. Pull back and regroup. THAT is ALL we should be doing because since my party started this fight they will not win? In November 2008? Things have only gotten worse if we are being honest.
16 // May 22, 2009 at 2:17 pm
liv&win: I agree with much of what you said in your response to me. I do think the lack of coverage is a problem, but the cause of the problem is, to a substantial degree, due to exorbitant costs.
I strongly favor universal coverage, but I think it would be a complete disaster if you don’t first, or simultaneously, implement real costs containment, which necessarily means some kind of rationing. I’m not aware of any system that achieves costs containment and universal coverage, except for single-payer or some other public-private hybrid.
I also strongly agree with you on end of life issues. Unfortunately, I think the religious beliefs of too many Americans make this issue a hard one. I don’t know if you’ve seen this article on end of life and faith, but I found it interesting:
http://articles.latimes.com/2009/mar/18/science/sci-faith18
Lastly, I disagree with your statement about our system being too structurally rigid to adopt some of the key components of other systems. First of all, it depends on what components you’re trying to adopt. More importantly, the only models we have that produce the results we’re seeking are the models of other countries.
That doesn’t mean we adopt those systems wholesale without any accommodation for our culture or the structures we already have in place, but it does mean we’re almost certainly going to have to simulate a lot of aspects of these foreign systems that have proven to be successful.
17 // May 22, 2009 at 2:26 pm
Sinz: You’re right that the GOP does want businesses to be free of these costs, but none of the GOP plans provide a solution b/c they don’t control costs.
Let’s assume all insurance premiums were tax deductible and pre-existing conditions were not an issue, many people still wouldn’t be able to afford insurance, most young healthy people still wouldn’t buy insurance, insurance premiums would still continue to rise and equally important, the country would still keep paying more and more for healthcare.
18 liv&win // May 22, 2009 at 3:30 pm
Thanks Spartacus for the link. Realities like that really makes the old noggin sputter. But, in my paradigm, I have a solution. Basically my solution is to universalize/socialize primary care by organizing health care resources into local health care districts (where you live, so you will heal) and keeps the secondary, RX and facility care financed by health insurance. This health insurance would be freed from all state mandates, available to all applicants, eliminates pre-exisiting conditions and establishes reasonable guidelines on switching plans. With these policies, patients buy the coverage they want and can afford. If end of life care is as expensive as it is, a plan that covered comfort care (hospice, drugs) might be 200% LESS expensive than a plan that covered end of life care. Everyone who wanted end of life care would select policies that cover that and no harm is done to the rest of the people who would rather not pay for or endure that trauma.
So, I agree with you too that some aspects of other countries plans are good candidates for helping us see how to reform our system. I was being narrowly focused on frances plan vs. a US version, not aspects of this or that.
19 sinz54 // May 22, 2009 at 5:42 pm
Spartacus: I have always been in favor of a mandate to force everyone to purchase health insurance. That forces young, healthy policyholders into the pool, as we did here in Massachusetts where I live.
Secondly, Senator Schumer, in YOUR party, is well aware that a public plan that appears to be “free” (zero premiums and zero co-pays) would cause employers to drop private group coverage, and cause many Americans with individual policies to switch to the public plan. And he’s working a compromise (see below).
I’m currently paying $465 a month in premiums to Blue Cross. Do you think I wouldn’t be strongly tempted to switch to a public plan with zero premiums and save myself $5,000 a year??? Who the heck would give up the opportunity to have “free” health care???
To fix that, Senator Schumer’s proposed compromise involves a public plan that charges premiums and co-pays, just like the private plans do. That way it can never drive the private insurers out of business by being “free.”
You mentioned Medicare. Medicare crushed 95% of the pre-1965 private insurance market for seniors, because of Medicare’s zero premiums. There may be an “option” to choose private insurance, but a retiree isn’t going to spend thousands of dollars on private insurance if Medicare is “free”–unless Medicare’s cost caps have caused his favorite doctors to stop accepting Medicare reimbursements. That’s been happening more and more. At least 25% of American doctors now refuse to accept Medicare reimbursements, because the caps are too low.
So if you think that a public plan can’t drive the private plans out of business, I suggest you tell that to Senator Schumer. He’s in YOUR party, after all.
20 sinz54 // May 22, 2009 at 5:48 pm
liv&win: The private insurers won’t sit still for eliminating pre-existing condition exceptions, if the pool of policyholders isn’t expanded. And if they oppose health care reform like they did in 1993, that could sink it.
You yourself said that many Americans, particularly younger Americans, don’t even bother to purchase coverage because they think they’ll be healthy forever. The result is that Americans will delay purchasing coverage till AFTER they’re diagnosed with a serious illness. Then the insurer will be forced to cover them (now that the pre-existing clause is dropped). If the insurer can’t make up in premiums what it will be paying out in claims, it will go bankrupt.
We faced that problem in Massachusetts. It’s a straightforward Grand Bargain: The insurers drop the pre-existing clause, in exchange for a universal coverage mandate which forces young, healthy policyholders into the pool. And that’s what the private insurers have told Congress for any national reform as well.
21 danbmil99 // May 22, 2009 at 5:56 pm
“The fact is, Republicans have a real opportunity to derail Democrats efforts, and the model is their 2007 defeat of immigration reform.”
Wow, that’s a positive agenda! What other goodies do you have in your GOP bag of tricks?
Don’t bother with a realistic, workable alternative. You didn’t bother with that on immigration. Instead, you accepted a status-quo where 10 million plus non-citizens are sort of tolerated but have no civil rights. Kind of like Apartheid. Yes, they broke the law. The problem is, we let them — practically begged them to. But I digress. The new agenda is to make sure 50 million people continue to use emergency rooms as their first line of defense against medical problems. How’s that working for you?
I’ve got a fancy new nickname for the GOP: The Derailleur.
22 // May 22, 2009 at 7:06 pm
liv&win: Your plan sounds like a huge improvement over the status quo, but how do you control costs for services that aren’t covered under the primary coverage?
Also, I think you need to have some minimum national standards for secondary policies. I think it’s fine to have multiple options, but there’s no evidence that the consumer will read or understand the differences btwn all the options.
I think you’d also have to mandate secondary policies, although they would probably be much cheaper since a lot of care would be covered by the primary policy.
23 // May 22, 2009 at 7:14 pm
Sinz: I know you’re in favor of mandate, but universal care, by itself, is not going to reduce costs enough. You’ll will have some savings due to preventative care, but almost certainly not enough to prevent economic disaster.
Any public plan that is intended to operate alongside private plans would naturally have to charge premiums. The difference is that the public plan, in theory, would be much cheaper mainly b/c of purchasing power.
As for Medicare, it does charge premiums. And, many private insurers participate in that market through the Medicare Advantage program.
24 danbmil99 // May 23, 2009 at 1:17 am
This whole issue is such a train wreck about to happen. Everyone knows the end game: health care becomes a nationalized, big-government service. There is no middle ground, except boutique services for the uber-rich.
Once you give up on the idea of insurance being an indemnity against risk, you’re pushed into the role of taking from the healthy to give to the sick. As others have said, insurance is now a misnomer: it’s collective payment that is averaged out among the group. That’s why it works in companies — you have a group, and it’s unlikely their aggregate health costs will be much different than the average.
This is indeed going to be massive redistribution of wealth — there’s no getting around it. Everyone has to contribute or the pool is skewed. It’s a new tax for a new entitlement.
25 sinz54 // May 23, 2009 at 7:10 am
Spartacus: Obama wants to eliminate Medicare Advantage entirely, if he can. Its budget was cut in Obama’s first budget.
26 sinz54 // May 23, 2009 at 7:16 am
danbmil99: I would certainly like to see some elements in health care reform that incentivize wellness. With auto insurance, you get a discount on your premium for being a “safe driver.” And your premiums are calculated based on your risk–your age, the neighborhood you live in, the amount of driving you do, etc.
Something like that could be carried over to health insurance premiums. Discounts for not being overweight or underweight; discounts for not smoking (we already have that discount with life insurance), discounts for not using illicit drugs, etc.
But health insurance isn’t like auto insurance in one big respect: Most folks junk their autos at some point and buy other ones. Whereas with your body, you are forced to keep getting medical care (and filing health insurance claims), as long as you can live. It’s like maintaining a 70 year old antique car. It’s going to be expensive.
27 liv&win // May 23, 2009 at 12:48 pm
sinz54: your not exactly correct about eliminating pre-exisiting condition limitations. We did away with them in the small group market 10 years ago in CA. there was no mandate and we even limited rate increases to 10% above the standard risk rate which are filed and approved by the DOI. Insurance companies want the mandate, but it is not necessary. I can explain later.
“You yourself said that many Americans, particularly younger Americans, don’t even bother to purchase coverage because they think they’ll be healthy forever. ” Actually what I said was that 25% of the uninsured are young 18-25 year olds. 40 million uninsured, 25% is 10 million. 10 million out of 150 million insured is not “MANY” it is just the opposite, is it “very few”.
Spartacus: what I propose for cost control in the secondary care area I discussed is complicated. At the core is transparency, freedom of choice, quality measurements and competition. It looks like this: you see your primary dr and you are told you need to see a specalist. Right there you get to see the availability and quality of all the specialists in the health care district. The specialist with the highest quality rating will probably not have an appt for 45 days. the specialist with the lowest quality rating might have an open appointment next friday. The patient gets to choose.
Competition for quality outcomes and the reward is compensation. The lowest quality doctors get 100% of medicare reimbursement. The highest get 200% of medicare and then there are 4 levels in between (1.0, 1.2, 1.4, 1.6, 1.8 and 200%). Your selection of insurance plan includes a choice on what quality level the plan will reimburse. So if you choose a plan that reimburses at 100% of medicare and you see a doctor that has earned through quality care 200% of medicare, that difference between the charges and the reimbursement would be the copay/deductible/out of pocket cost or whatever you want to term it.
28 liv&win // May 23, 2009 at 1:05 pm
Spartacus: Yes, I would mandate the secondary insurance coverage. And because you are taking billions of primary care transactions out of the picture, the cost of the coverage would be reduced in both administration and pure insurance costs.
The purchasing decision on the insurance is chiefly financial for the individual: do you want prescription drug coverage for generics only, formulary only, or full coverage. do you want level 1, 2, 3, 4, 5 or 6 specialist coverage. do you want 100-10000 deductible for facility care? It is so straight forward that you can even build your policy starting with how much you can afford to pay. You want to pay $150 a month? You can afford level 2 specialist coverage, formulary rx and a $5000 facility deductible.
I have to say that I envision this replacing all current plans and programs currently being used. I am philosophically opposed to any legislation that does not apply to everyone. I think where laws are concerned, every citizen should be equal.
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