Friday, January 7, 2011

Republican health care "plan": file not found

The Republicans are planning to have a vote with the intention of repealing the recently passed health care reform bill. They want to scrap the bill entirely and start from scratch, they say. If the Republicans had their way to begin with, we wouldn’t be talking about all this reform business at all—you know, let the “free market” make a mess of things, and it will all "work out" in the end. Of course in the “free market,” health care means weeding out all the sick people and making huge profits off the healthy people. However, since there is a health care law on the books, the Republican leadership cannot simply scrap it and say they won’t replace it; everyone except the Republican rank-and-file, Tea Party people and the insurance industry knows that there are serious problems with the health care delivery system in this country and its ever ballooning costs, and it will only get more out-of-control with no tinkering at all.

The Republican leadership knows this. This why they have just installed a new webpage with “details” of their health care ideas; it’s a mistake to call them “reform.” When I clicked on the “summary” and “text” PDF links to the Republican health care plan, I was redirected to a “file not found” page. But not to worry; the Republicans do have certain propaganda “principles” that Der Fuehrer Boehner wishes you all to know and understand (I couldn’t help myself: “Leader Boehner” has a fascist feel to it).

For example: “Let families and businesses buy health insurance across state lines.” This idea has already made the rounds and has been found wanting. The problem is that health care costs—and thus insurance costs—vary from state-to-state. You might live in California and purchase a North Dakota plan, but if the Dakota plan has a coverage ceiling that is applicable to that state and is much lower than a similar cost in California, the purchaser of that insurance may soon rue his or her choice. This “plan” thus hurts consumers and is a fraud.

Principle number two: “Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.” Sounds like a fine idea; the problem is getting insurers to get on board without the government regulation that Republicans and tea partiers abhor in “Obamacare.” Insurers will fight tooth-and-nail against creating a “pool” of individual insured. An individual might pay a $100,000 in premiums while never seeing a doctor over a ten year period, until they can’t afford the annual rises in premiums meant to price them out of the market. There will always be somebody else to replace them, so this is a cash cow for the insurance industry.

Principle number three: “Give states the tools to create their own innovative reforms that lower health care costs.” Most states already do have their own “tools,” like Washington’s Basic Health; since it is a bare bones program strapped for cash, it is unlikely that either unspecified or the usual unworkable “free market” ideas without regulation are “innovative” enough to be of any use.

Principle number four: “End junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it's good medicine, but because they are afraid of being sued.” In other words, tort reform. The idea is that doctors will be more apt to do the functions they are paid for if they have no fear that if they end-up killing someone on the operating table because they left a scalpel in the patient’s liver, they can’t be sued for very much. Isn’t there something called the Hippocratic Oath in the job description?

There are, of course, actual “bills” that were discussed and discarded during the formulation of the current health care law. They are worth noting only because of their habit of redundancy, although the “page not found” that greeted me when I hit the link for “Medical Rights and Reform Act” probably best defined their utility as “reform.” “Empowering Patients First” actually encapsulates most of the Republican “ideas,” and perhaps not surprisingly has very little to do with “empowering” patients. Tax credits are fine, except that the Republican idea is to expand them so far that their ultimate effect is to increase the federal deficit dramatically while being only sufficient to pay for bottom-barrel coverage; it’s just another backdoor tax cut. In place of affordable preventative medical coverage, there a “self-responsibility” wellness “incentive” that allows employers to determine if an employer is following “healthy” habits and institute a premium discount; if it sounds like BS, it probably is. There is a “cost-cutting” proposal that seeks to establish “health court tribunals” which essentially give insurers the decision to determine “best practices.” Of course, insurers already do that in the name of denying needed care; the Republican “plan” merely enshrines it into accepted practice. There is also a proposal that grants states “incentives” to establish “high risk” pools for people with pre-existing conditions, and expands federal block grants to help pay for these “pools”—which, of course, sounds vaguely familiar to the current reform law. I’ll grant one useful idea: providing incentives for medical students to become primary care physicians instead of high-paying specialists, such as loan payment assistance and deferrals. There is also an employer auto-enroll option with an employee “opt-out” clause—which is just a fig leaf to Tea Party types upset by the allegedly “unconstitutional” portion of Obamacare that will eventually oblige people to pay a stipend if they do not want insurance, just as they do Medicare taxes; in fact most states already allow employers this “option.”

But the over-all thrust of the Republican “plan” is that same hands-off market-oriented shibboleths they have pushing as an “alternative” to the Obama plan from the beginning. The “market” has failed us as a mechanism for social good not just in health care, but in ever increasing income disparities and off-shoring jobs. One must confess that the current reform package is greatly wanting in that it does not offer an affordable public option that is not subject to the whims of insurance companies, but what it does to do is address most of the insurance company abuses that habitually denied care not just for pre-existing conditions, but post-existing conditions; the Republican “plan,” such as it is, allows insurance companies to roam free without hindrance. The ultimate effect of their "ideas" is to raise the deficit far more than what they claim for “Obamacare” while failing to address the abuses by insurance companies that have led to the problems to begin with. That is to say, of course, that Republicans eventually formulate a "plan" at all.

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