The Democrats are pushing hard, very hard, to get health reform passed this year. Heck, they want to get it done this summer. And so far, the GOP’s involvement has been limited to standing on the sidelines lobbing rhetorical rocks at pretty much every aspect of reform – and getting little traction in return.
That may change – if they stop repeating pollster Frank Luntz’ talking points, and focus on the real issue – cost.
Today offers the GOP a chance to do just that; the CBO’s scoring of Sen Kennedy’s (D MA) proposal indicates it will cost over a trillion dollars over ten years and only cover 15 million more Americans. This is an initial draft bill, there is much left to do, and the final bill will likely address many of the CBO’s concerns; but it does offer the GOP a chance to focus on the real issue.
Which so far they haven’t done.
President Obama is wooing doctors, employers, politicians, health plan execs, people with a plan that builds off the current employment-based system supplemented by a public plan option. The President, and most of the Dems in Congress, strongly support reform efforts that do not eliminate the current employer-based system.
(Personally, I’d prefer to see a system that eliminates the employment linkage for reasons of portability and efficiency, and to allow employers to get out of the health insurance business, but I can’t say that publicly because my good friends who are insurance brokers will blow up my house.)
Looking just a bit deeper into what looks like the bare bones of reform, it appears:
– some form of mandated coverage will become law, likely over several years;
– strict controls on medical underwriting, risk selection, rating, and benefit design will be mandated;
– some form of medical liability reform will be passed;
– physician payment will be altered to favor primary care;
– supplemental payments to insurers for Medicare Advantage will be dramatically reduced;
– pharmacy costs for Medicare and Medicaid will be slashed (either by a mandated rebate or price negotiation); and
– hospital reimbursement will be cut rather significantly.
There’s no question that’s a lot of ‘change’.
But it is change that appears to be welcomed by Americans. For most voters (the key constituency here), there’s not much in the way of wildly objectionable issues. This isn’t a single payer solution, individuals won’t be forced to get coverage for several years, those currently covered by a health plan at work will continue to get that coverage, docs will continue to practice and pick the insurance companies they work with and bill like they do today.
From a Kaiser Foundation poll to be released today:
“A solid majority of the American people (61 percent) continue to believe that health reform is more important than ever given the country’s economic problems; sizable majorities support key elements of reform currently being debated such as employer mandates (69 percent), individual mandates (71 percent), and a public plan option (65-67 percent depending on wording)…A narrow majority of the public (53%) supported limiting future increases in how much doctors and hospitals are paid under Medicare to help pay for health reform (37% opposed)…A large majority (70%) liked the idea of insurance exchanges–tested with different descriptions–as a way to help people purchase insurance on their own.
And according to the KFF poll, a majority of Democrats (68%), Republicans (69%) and independents (75%) agreed insurance exchanges that guaranteed that “participating plans would not deny coverage to those with pre-existing conditions or charge higher premiums to those who are in poorer health” would be helpful if one had to purchase health insurance on one’s own.
I’m kind of puzzled by the way Republicans are reacting to the Democrats’ strategy, reform initiatives, and tactics.
Here’s how the Republican Congressional leadership reacted to President Obama’s speech to the AMA yesterday.
John Boehner, D OH
“We’re pleased the President has expressed rhetorical support for medical liability reform, but fact is the effect of even the strongest medical liability reforms would be negated by a government takeover of health care that raises taxes, rations care, and drives health care costs even higher.”
Eric Cantor, R VA
Democrats are touting a government-run health care option that creates an unlevel playing field leading to the destruction of the private market, reducing choice and putting Washington bureaucrats in charge of family health care decisions. In addition, their approach will cost over a trillion dollars – money this country simply does not have.
“There is a growing chorus of concern about the Democrat’s trillion dollar government health proposal. More campaign-style events and speeches do not give the American people the answers they need. Can Americans keep what they have if they want to? How will this Administration pay for it? Is it productive for government to restrict our doctors’ ability to treat patients as they see fit? Serious questions remain unanswered, and it’s time for the Administration to end the happy talk and get down to the difficult decisions ahead.”
Sen. Jim DeMint R SC
“I’m working on a bill to give *every* American access to health care they can control, without forcing them into a government rationed plan” [Twitter, 6/10/09; emphasis added]
Sen. John Barrasso R WY
“Their plan is what we know doesn’t work in England, doesn’t work in Canada – it is a complete Washington takeover of health care.”
Rather than engaging on meaningful issues, the GOP is sticking to Republican strategist Frank Luntz’ talking points.
Here are examples.
“some bureaucrat puts himself between you and your doctor, denying you exactly what you need.”
Wait, isn’t that what happens today in the vaunted private insurance sector?
“THEY decide if you’ll get the procedure you need, or if you are disqualified because the treatment is too expensive or because you are too old.”
Deja vu…
reform should “protect the sacred doctor-patient relationship, and allow people to choose the personal care that suits their individual needs.”
Double deja vu…
“The plan put forward by the Democrats will deny people treatments they need and make them wait to get the treatments they are allowed to receive.”
I don’t see this working. Or rather, if the President continues to stick to his talking points, and if the reform bill that emerges follows the current path, the GOP will find itself arguing against a bill that exists only in their minds.
The GOP is already smarting from its label as the “Party of No”. If they continue to avoid meaningful engagement, that label will get increasingly sticky.
That’s bad for them, and bad for the country. The big winner is cost control. The President is finally addressing the cost issue, and his announcement that the plan will cost about a trillion dollars over ten years is the big opportunity. I don’t often offer advice to the GOP, but I’d suggest that the cost issue is where they can regain their long-lost reputation as the party of fiscal restraint. As presently configured, health care reform is unaffordable. We need reform, but we need reform we can afford.
Given the GOP’s proclivity towards parroting Luntz’ anti-clinical guideline nonsense, this may not be possible, but the way to control costs while ensuring higher quality is to make sure patients get the right care, docs are rewarded for delivering that care, and not for providing unnecessary, expensive, and unproven care.
Instead of fighting comparative effectiveness, the GOP should embrace, strengthen, and support it as a way to hold down costs.
I don’t see that happening, as they appear convinced that their future is assured by following Nancy Reagan’s time tested “Just Say No”.
Jun
16
The Republican Party leadership is totally out of touch with what the majority of the country is asking for and needs. It is like GM and Chrysler of a few years ago, still trying to sell its product and ignoring the customer.
I, for one, no longer consider myself a Republican because of the many differences in beliefs and it’s total lack of responsiveness and awareness.
Joe
I think your description of what the Democrats are shooting for–and what is likely to happen over the next three years is very accurate.
I also believe that employer-base insurance will gradually disappear as everyone becomes more comfortable with the Exchange.
And this will be good–for the reasons you cite.
Finally, on what’s wrong with the Republicans?
In the 1990s, the conservatives who took over the party were intellectually bankrupt.
Karl Rove and the others had no ideas–just bumper stickers. They replaced ideas with ideology.
See Greg Anrig’s book “The Conservatives Have No Clothes.” (Full disclosure — Greg is a friend and my boss at the Century Foundation.) .
Healthcare reform proposed by the Federal Government may actually eliminate affordable medical insurance from the private sector entirely. While publicly funded healthcare may seem to create affordable medical insurance for more Americans, it may actually create a bigger problem.
Private medical insurance is not the enemy of affordable healthcare in the US. In fact, if the federal government creates another public healthcare program, it will ultimately raise the costs of private medical insurance to exorbitant levels. While the idea of expanded public healthcare may seem to be the answer to affordable medical insurance, it could be the end of private insurance altogether. Medicare and Medicaid, the two public health programs currently in effect, cost private insurance companies – and by extension, Americans paying premiums for private insurance- $88 billion in 2007, according to the consulting group Milliman, Inc. In fact, the average family of four with private medical insurance saw their premiums increase $1500 because of public programs. In California alone, that represents nearly 10% of every premium dollar paid.
The problem comes because Medicare and Medicaid pay as much as 15% to 30% less than private insurance companies on every doctor and hospital bill. Because the doctors and hospitals aren’t willing or able to accept this much loss, they push those losses onto private insurance companies, who, in turn, shift the loss to the consumer through higher premiums.
Private insurance companies must not only cover their costs and earn a profit; they also need to maintain a reserve of cash to pay out claims. If a new public health care program is developed and then pays medical costs at a reduced rate like the current systems do, it means there will be an increase in expense shifted onto private insurance to make up the difference. This increased cost will need to be offset through higher premiums for the people covered under private medical insurance plans. As those who have private insurance become forced to pay increasingly higher premiums, the number of Americans who no longer find private insurance an affordable health coverage option will increase. Those people will then need to turn to the newly formed public healthcare program and will then become part of the increased costs passed on to private insurance by underpaid doctors and hospitals.
As more unpaid costs from private health insurance continue to be pushed into premium prices and more people become unable to pay those premiums, eventually private health insurance will be completely unable to compete with public programs and will face the inability to stay in business. Affordable healthcare in the private sector will become impossible to find.