RSS Feed MenuAre the wheels coming off the Democratic plan to revolutionize American health care? We can only hope so. But as Republicans resist the new controls, new taxes, and new government expansion proposed by Democrats, they need to be very careful to avoid the opposite mistake: defending an indefensible status quo.
The American health-care system is a costly and inefficient quagmire. It spends dramatically more than any other health-care system on the planet, while producing (at best) only marginally better results. Wages are stagnating for middle-income Americans because of the surge in health -are costs. Fear of losing insurance deters many from switching jobs or striking out on their own. The uninsured get sicker, and the inadequately insured worry that illness will lead to financial ruin.
Many of these problems bear especially heavily on groups Republicans are generally expected to champion: small businesses and the self-employed. At the beginning of the summer, I was talking to a small-business owner and lifelong Republican who said: “If Barack Obama will take my health-care costs off my books, he can charge me whatever he wants in personal income tax—it’ll be worth it.”
What is the competing offer from Republicans?
Though you wouldn’t know it from the current debate, Republicans actually have an inventory of useful ideas to offer Americans concerned about the rising cost of health coverage. Republicans have proposed allowing the sale of insurance products across state lines, enabling people in expensive states like New Jersey to benefit from the less expensive regulatory regime in, say, Kentucky. Republicans have proposed creating health-care exchanges—like the one fashioned by former Gov. Mitt Romney in Massachusetts—to enable the self-employed to buy insurance with untaxed dollars, just as larger businesses can. The first President Bush proposed an audacious series of subsidies for the uninsured, to be paid for by taxing the benefits of the most generous employer-provided health plans.
Unlike President Obama’s grand schemes, these measures represented incremental changes to the status quo; they could have been implemented gradually, allowing everyone time to assess their effect while giving the system time to adjust. That’s the way to make big changes to something as vital and complex as American health care.
Despite these good ideas, the GOP failed to make health-care reform a priority when it held power. As a result, we Republicans forfeited our credibility on the issue. Strikingly, the Republican with the biggest health -are story to tell—Mitt Romney—declined to trumpet his achievements in the 2008 Republican primary contests, having accurately gauged that they would do him little good. (The Romney plan had trespassed conservative orthodoxy by including, among other offenses, a mandate that imposed a tax on individuals who failed to buy one of the new health policies created by the plan.)
Republicans are in danger of forgetting one of the primary rules of politics: Voters do not care what you know until they know that you care. On health care, we do not look like we care.
So as the Hydra-headed Obamacare lurches through the halls of Congress, we can be confident in our opposition; the president is overreaching horribly. He seeks to herd millions of Americans into a government-operated plan. His promises of cost control are pure assertion, fantasies based on hope and guesswork. He will pile new taxes on small business and crushing new regulations on America’s most innovative industries. He has a bad plan, deserving of intense opposition.
But if Republicans prevail, as I hope we do, then what? Can we provide a vision larger than merely inflicting defeat on a Democratic president and Congress? Can we offer a better alternative? And will we do the hard work to make health care a priority after Obamacare is beaten back, assuming it is? If Republicans can play a constructive role on the toughest of issues, we’ll have taken our first important step on the road to political recovery. If not, a victory over an ambitious president may prove an empty one, both for Republicans and for the country.
Originally published in The Week.
Spartacus // Jul 24, 2009 at 3:32 pm
barker13 // Jul 24, 2009 at 3:06 pm wrote: “Do you accept or reject Epstein’s contention that “medical malpractice premiums constitute well under 1% of the total U.S. health-care bill, but defensive medicine adds perhaps as much as 10%?”
I don’t have any basis for agreeing or disagreeing with Epstein. However Epstein’s premise, which is if you implement caps on medical malpractice awards you will reduce the practice of defensive medicine, is highly doubtful and he did not produce any evidence to support it. California has had caps on med malpractice awards for many years and it has not slowed the rate of growth for healthcare costs. And, as I said in my initial post, the rates of growth in costs for states with tort reform is comparable (sometimes higher) than those without tort reform. That is what I meant by “not significant” (i.e. it does not produce a measurable benefit when compared to states without reform).
Intuitively, I would guess that most defensive medicine is the result of consumer demand and increased technology/new drugs. Most people are probably inclined to believe that the newest drug/technology is the best and it will better detect or treat the problem. As a consequence, both doctors and patients are probably inclined to order these new treatments, which are probably much more expensive than the older treatments.
Another reason I doubt the efficacy of tort reform in constraining costs is that you if pay attention to the debate about reform you simply don’t hear the stakeholder (doctors, hospitals, insurers, drug companies, etc.) clamoring for tort reform. Whereas, years ago before many states implemented tort reform, many stakeholders argued for, and received, med mal caps. It probably helped lower legal costs at the time, but I doubt it changed the way medicine is practiced. Are doctors in states without tort reform really practicing medicine differently (i.e., less defensively) than doctors in states with tort reform? I doubt it. I suspect most doctors in all states do what they think the prevailing research warrants irrespective of whether or not they live in a tort reform state.
barker13 // Jul 24, 2009 at 5:56 pm
“…Epstein’s premise, which is if you implement caps on medical malpractice awards you will reduce the practice of defensive medicine, is highly doubtful…”
Hmm. Perhaps. Setting that aside, *my* premise is that malpractice insurance premiums are an expense passed ultimately to patients and thus a factor in the cost of medical care. Agreed?
“California has had caps on med malpractice awards for many years and it has not slowed the rate of growth for healthcare costs.”
The growth could be coming from other expenses that are “unique” to California. (In other words, perhaps the caps actually HAVE slowed what would otherwise be the rate of growth in healthcare costs, only this savings has been canceled out by comparatively faster growth in other California cost factors?) (*SHRUG*)
“…as I said in my initial post, the rates of growth in costs for states with tort reform is comparable (sometimes higher) than those without tort reform.”
I’d like to look over the data for myself. Would you be so kind as to provide a link? Thanks!
“Intuitively, I would guess that most defensive medicine is the result of consumer demand and increased technology/new drugs.”
And I wouldn’t disagree. But this brings us back to the disconnect between what individuals demand and what individuals are willing to pay for and how our present system of “extended warranty type service” with deductibles and second/third party billing artificially creates demand – or… at the very least… creates less incentive for patients themselves to want to look at medical expenses as they do other expenses, cost/benefit wise that is.
“Another reason I doubt the efficacy of tort reform in constraining costs is that you if pay attention to the debate about reform you simply don’t hear the stakeholder (doctors, hospitals, insurers, drug companies, etc.) clamoring for tort reform.”
I hear it. (*SMILE*) Shall I send you links…???
“Are doctors in states without tort reform really practicing medicine differently (i.e., less defensively) than doctors in states with tort reform? I doubt it.”
I don’t know. And I freely stipulate, I certainly don’t think you’re irrational to doubt it. It’s a fair question, one I’d like to know the answer to.
BILL
ottovbvs // Jul 24, 2009 at 6:51 pm
macandcheese // Jul 24, 2009 at 2:39 pm
“Now onto your rather impolite assertions about my postings — I never said that tort reform was the biggest cost associated with health care but it is an issue and a political tool which can and should be brandished if for no other purpose than to countermand the democratic argument that doctors routinely perform unnecessary procedures like removing tonsils for no reason other than to collect fees; as Obama suggested.”
……………It’s a totally unimportant issue but by all means hang your case on it if you want to it just makes it more easy to dismiss which is why it’s disappeared from the Republican talking point list ……..and that doctors perform unneeded tests and procedures to produce revenue was I would have thought was one of the worst kept secrets in medicine……Sinz actually provided a personal example ……some like Barker or at least his source say it’s defensive medicine and amounts to 10% of total expenditures…..that’s almost 2% of GDP if you believe him…….Why else would some med district in the boondocks of Texas be spending three times what they are spending in the Mayo clinic district
…………As for the your suggestions the Obama admin demonized Wall Street……you don’t think that had happened before he was even elected…….Clearly you think the entire healthcare industry, the financial industry and the energy industry are paragons of virtue……they’re not……and basically the Obama admin has rescued the auto industry and wall street and the AMA and nurses organizations have endorsed some of bills coming out of congress so I’m not sure where you’re coming from with this one…..bash Obama with a political tool let’s not worry about the facts I guess
“But you and sinz54 seem to be somewhat oblivious to the nuances and opinions of other people’s posts which suggests to me that you may not be quite as clever as you think. You are certainly not as polite as perhaps you should be”
…………given the nature of your posts you don’t really need to be very clever (which I’m not) to figure them out……Personally I’m somewhat addicted to fact based analysis……if you wish to advance weak propositions you must expect to see them questioned
Spartacus // Jul 24, 2009 at 8:21 pm
barker13 // Jul 24, 2009 at 5:56 pm
Medical malpractic premiums are certainly a cost component that gets passed on to the payer along with all other cost components. So, yeah, if you slow the growth in med mal premiums you will slow the growth in healthcare costs, but that’s also true for pencils, office furniture and iodine. The issue is whether med mal premiums are growing faster than inflation as is the case with healthcare costs. The links below suggests that (1) tort reform did, for a time at least, slow the growth in med mal premiums, and (2) med mal premiums did not grow as fast as inflation, in fact for a period of time med mal premiums actually went down and healthcare costs continued to rise.
http://www.gao.gov/new.items/d04128t.pdf
http://www.insurance-reform.org/StableLosses2007.pdf
I’m not opposed to med mal caps as a part of healthcare reform. I simply opposed to the red herring of tort reform as a significant component to controlling healthcare costs because (1) premiums are only 1%, (2) healthcare costs have risen even during periods of time that med mal premiums have gone down, and (3) there’s no evidence that it leads to less defensive medicine.
I’m still looking for a link about the growth in healthcare expenditures in states with tort reform vs. states without it. I heard that a conference so I don’t have written substantiation.
sdspringy // Jul 24, 2009 at 9:37 pm
Sinz54:…
– The latest and most expensive new technologies. No patient is going to reject a treatment simply because it costs too much: “Oh, that treatment is too expensive. Just let me die instead.” Hence whatever treatments can improve the quality of life, and extend lifespan, are demanded as soon as they reach FDA approval.
This last point illustrates how health care represents a market failure: If we assume that a human life is infinitely precious, then there can be no cost constraints on saving that life. Hence the supply and demand curves for new technologies don’t intersect at a point that society can reasonably afford.
Isn’t this the dirty little secret of healthcare reform. The government determining which life saving mearsures will be allowed. How else, or where else are all those Medicare saving going to be realized.
The other dirty little secret is once the government runs your health care, don’t they also run your life. Do they not then dictate which life styles, ie.. smoking, drinking, drive thrus, BFI, (body fat index) is appropriate.
The reason the USA spends more than anyother country on healthcare is because we can and we want to. Same with cars and the nunber of miles driven by US citizens is greater than anywhere else. You may think that is selfish and that I should not have that, dare I say, freedom.
But that is my personnal responsibility to determine where and how my money is spent. Now some people say other people cannot afford healthcare. That is not necessarily true. They can always get some sort of healthcare policy. May not be the same as the guy across the street but no where in this country is he denied the opportunity to improve that condition.
If government run healthcare becomes a reality, nobody will have the freedom to make those decisions.
Spartacus // Jul 25, 2009 at 7:21 pm
sdspringy // Jul 24, 2009 at 9:37 pm wrote: “Now some people say other people cannot afford healthcare. That is not necessarily true. They can always get some sort of healthcare policy.”
Apparently, you’re not very familiar with the way healthcare works in this country. Many people cannot get insurance no matter how much they’re willing to pay. If you are sufficiently sick, no insurer will offer you insurance because the amount of care you will require will cost way more than the insurer could ever collect from in in the form of insurance premiums.
You also wrote: “Isn’t this the dirty little secret of healthcare reform. The government determining which life saving mearsures will be allowed.”
You’re right about this, but your question implies that currently the patient or doctor determine what life saving measures will be allowed. That, however, is not the way things are. Currently, the insurer (not the patient or the doctor) determine what measures are allowed. So the question is, is it better to have a profit-motivated insurance executive or a bureaucrat at a Federal Reserve-type agency make that determination? They both have potential incentives for making decisions that may conflict with the wishes of either the doctor or the patient. Equally important, should the patient or the doctor be able to force either the insurer or the government to pay for a treatment for which there is no evidence it will be effective? No health insurance policy requires an insurer to do this.
You wrote: “The reason the USA spends more than anyother country on healthcare is because we can and we want to. ”
Well, you’re only half right. We certainly want to spend all the money we spend, but we certainly can’t afford to, which is why so many companies are dropping coverage for their employees and it’s also one of the biggest reasons why the U.S. has such a large budget deficit.
sdspringy // Jul 25, 2009 at 9:49 pm
Spartacus, you have some misconceptions. The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.
Health insurance covers the majority of cancer treatments, transplants, and other wide range of procedures. The possibility of lack of coverage however does not prevent the patient for seeking treatment through other financial means. The question about government run healthcare is, even if the medical procedure is covered will individuals be denied access. Being deemed not appropriate because of the patients age.
And the US budget deficit has absolutely nothing to do with healthcare. Unless you are willing to blame Medicare and Medicad. Which should enlighten those who think a government provided healthcare can reduce cost.
ottovbvs // Jul 26, 2009 at 10:49 am
sdspringy // Jul 25, 2009 at 9:49 pm
“Spartacus, you have some misconceptions. The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.”
…………..I’m unfamiliar with HIPPAA perhaps you’d like to tell us what it is……….but the notion that it’s possible for someone with a pre-existing condition to obtain health insurance at an economic prices indicates that your either totally ignorant of reality or spinning…….as for this statement:
” The possibility of lack of coverage however does not prevent the patient for seeking treatment through other financial means. ”
……….Perhaps you’d like to tell us what those are exactly
ottovbvs // Jul 26, 2009 at 11:03 am
sdspringy // Jul 25, 2009 at 9:49 pm
……….Just for kicks I went to one of these legal forum websites where people can ask for advice when they can’t get coverage for pre-existing conditions………follow this link to learn what a minor problem it is:
http://www.expertlaw.com/forums/showthread.php?t=13173
…….btw reading this jogged my memory on what HIPPAA is……..it’s the legislation Clinton passed in the mid 90’s to tidy up the state and fed law on job changes etc…..to be honest I didn’t know it was called HIPPAA
barker13 // Jul 26, 2009 at 11:29 am
Re: Spartacus // Jul 24, 2009 at 8:21 pm –
“…if you slow the growth in med mal premiums…”
I don’t want to just “slow the growth;” I want to reverse the trend. That’s why I favor tort reform.
“I’m not opposed to med mal caps as a part of healthcare reform.”
(*HANDSHAKE*)
Re: Sdspringy // Jul 24, 2009 at 9:37 pm –
“If we assume that a human life is infinitely precious, then there can be no cost constraints on saving that life.”
Exactly.
Re: Sdspringy // Jul 25, 2009 at 9:49 pm –
“The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.”
And the Springster hits one out of the park!
(*THE CROWD GOES WILD*)
Anyway…
ONE
MORE
TIME
What we need is affordable catastrophic care insurance coupled with affordable regular healthcare accessibility.
The FORMER is an INSURANCE issue.
The LATTER is more about “re-educating” the American People to accept the reality that government policies from the ’40’s (WW-2 wage/price controls and using health benefits as a tax free carrot) are what got us in to this mess in the first place.
No matter how many multiple threads – one after another… day in, day out… week by week, month by month – Frum and his “contributor’s throw on this site and no matter how many (literally!) thousands upon thousands of reply posts we post in response, it really does come down to that.
BILL
ottovbvs // Jul 26, 2009 at 12:26 pm
barker13 // Jul 26, 2009 at 11:29 am
“I don’t want to just “slow the growth;” I want to reverse the trend. That’s why I favor tort reform”
……..The innumerate rambles on…….total malpractice premiums and payouts are 1% or less of total healthcare costs…….if half of it disappeared tomorrow it wouldn’t make a dimes worth of difference to slowing growth let alone reversing the trend……….. Duh!
sdspringy // Jul 26, 2009 at 7:39 pm
Otto:
There exist many links explaining HIPAA and the insurance reform for preexisting conditions. Just do alittle reading.
As always this debate will evolve into who will take care of me. And of course someone else is supposed to pay for it.
Insurance is always available, you may not like the cost of the premium, but that is usually directly proportional to the cost of care you want. Which is why any reference to Medicare or Medicad should point out that they are budget busters. Huge expenses, and nobody want to pay for them. You will not be able to tax the upper 5% to cover the cost of healthcare for the remaining 95%.
Spartacus // Jul 26, 2009 at 9:41 pm
sdspringy // Jul 25, 2009 at 9:49 pm wrote: “Spartacus, you have some misconceptions. The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.”
Thanks for the response, but you are very, very wrong. Most states in the East do not allow insurers to deny coverage based on preexisting conditions; most states in the West and elsewhere. Please see the link below for indisputable proof that California, the largest insurance market in the country, permits insurers to deny coverage based on preexisting conditions.
http://www.insurance.ca.gov/0100-consumers/0070-health-issues/ind-health-insurance-underwriting-ab-356.cfm
I hope this does not sound offensive, I truly do not intend it to be, but does the fact that you’re very wrong about an extremely basic concept in health insurance cause to consider that you probably don’t really know much about problems in the healthcare market and, therefore, you probably should not form any firm opinions one way or another until you learn a little bit more? Also, would this fact not strongly suggest that when in the process of learning more, you should probably pay more attention to those who’ve been right more often than those who’ve been wrong more often?
Spartacus // Jul 26, 2009 at 9:43 pm
Sdspringy, I just noticed I failed to complete the first sentence in the 2nd paragraph of my post. I meant to say that most states in the West and elsewhere do permit insurers to deny coverage for preexisting conditions.
barker13 // Jul 26, 2009 at 10:09 pm
Re: Spartacus // Jul 26, 2009 at 9:41 pm –
Hmm… (*NOD*)
OK. I started out by following your link. According to your link… you’re right! No doubt about it! Call me Obama for automatically taking Sdspringy’s assertion regarding HIPPAA as gospel.
My bad…!
But then I turned to researching HIPPAA.
Now THIS is weird – and I’m guessing it’s not the only disconnect I’d find if I were to go looking:
From YOUR link:
http://www.insurance.ca.gov/0100-consumers/0070-health-issues/ind-health-insurance-underwriting-ab-356.cfm
“What health conditions will cause a health insurance company to automatically refuse or deny my application for insurance?”
Among the MANY conditions listed… they specifically include “Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process;”
Now… contrast this with:
http://library.findlaw.com/1999/Jun/1/127540.html
From paragraph #4 –
“Another significant feature of HIPAA is the fact that it prevents pregnancy from being treated as a pre-existing condition. Pre-existing condition exclusions cannot be applied to pregnancy, regardless of whether the woman had previous coverage. Additionally, a pre-existing condition exclusion cannot be applied to a newborn, adopted child under age 18 or a child under 18 placed for adoption, as long as the child became covered under the health plan within 30 days of birth, adoption or placement for adoption, and provided the child does not incur a subsequent 63-day break in coverage.”
Weird, huh….???
BILL
Spartacus // Jul 27, 2009 at 7:37 pm
barker13 // Jul 26, 2009 at 10:09 pm
I’m guessing that when Congress enacted HIPAA it wanted to specifically address the issue of pregnancy as a preexisting condition. As you probably remember from your high school civics course (assuming high school had been invented by the time you were a teenager:)), Congress has the power to preempt state legislation. Maybe HIPAA preempts state rules regarding the classification of pregnancy as a preexisting conditions.
barker13 // Jul 28, 2009 at 9:26 am
Re: Spartacus // Jul 27, 2009 at 7:37 pm –
“Maybe…”
“Maybe…???” What are you – the POTUS? (*GIGGLE*) A congressmen or Senator? (*SMIRK*)
“Maybe” doesn’t do us much good, Spart. (*WINK*)
Oh… and speaking of what I remember… I seem to remember some sort of technology which allows revision of… oh… laws and such… when certain sections no longer apply.
(*GRIN*)
BILL
becks71 // Aug 10, 2009 at 5:55 pm
Reversal of Republican Values?
“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. This is not a way of life at all in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron. ”
Dwight D. Eisenhower, April 16, 1954
Yet we can afford to be the policemen for the world and support dictators and despots. We can triple earmarks for unneeded projects. We can do all those things but cannot afford health care reform? I have the answer and its not Republican.
Or is it not invented here syndrome ?