OP-ED

No Alternative: An Analysis of the GOP Plan

Congressional Republicans have been blasting away all summer at the Democrats’ health reform legislation. But they might face heavy blowback if more Americans took a close look at two ambitious health reform bills sponsored by GOP lawmakers.

While the GOP plans include some worthy ideas, they have fatal policy flaws at their heart, largely related to insurance risk selection. Plus, they’re vulnerable to many of the same big-government political attacks leveled against the Democratic proposals. That may be the reason Republican lawmakers aren’t talking up their plans at the stormy health care town hall meetings they’re hosting across the country.

The two bills – the Patients’ Choice Act (PCA), sponsored by Oklahoma Sen. Tom Coburn and several House Republicans, and the Health Care Freedom Act of 2009 (HCFA), sponsored by South Carolina Sen. Jim DeMint – have a fair amount in common, though DeMint’s bill is the more conservative and deregulatory of the two.

More surprisingly, each bill shares some features with the Democratic proposals – including health insurance exchanges, subsidies for the uninsured to buy coverage, insurance market reforms, accountable health organizations, and a national rulemaking commission. The sad part of the nasty, mendacious political debate this summer is how little Republicans and Democrats have focused on those big areas of agreement.

Despite his bill, DeMint has said that he wants to turn health reform into President Obama’s “Waterloo” and “break him.” On the hustings, he has spoken little about his own proposal. Similarly, Coburn didn’t mention his plan when a sobbing woman at an Aug. 24 town hall asked for his help in getting insurance coverage for her brain-injured husband. He coolly told her that government is not the solution and people needed to take care of their neighbors.

Yet Coburn’s PCA opens with a critique of the current U.S. health care system that could have come from Obama. “The health care system in America is broken,” the bill summary says. “Costs are rising at an unacceptable rate… and 47 million Americans worry what will happen to them or their children if they get sick… Universal access to affordable health care for all Americans should be guaranteed.”

So the Republicans agree on the problems. But how do they propose to solve them?

Refundable Tax Credits

To expand coverage, both GOP bills would give people refundable tax credits to buy private insurance. The PCA would offer all individuals $2,300 a year and all families $5,700, while the HCFA would give $2,000 and $5,000 only to individuals and families without job-based coverage.

The PCA would finance these subsidies by eliminating the current tax exclusion for employer-paid health coverage. The HCFA would finance the subsidies by repealing the financial industry bailout program and requiring prompt repayment of those loans, though that would only be a one-time moneypot.

There are a number of political and policy problems associated with these provisions. First, the subsidies would cover less than half the cost of the average, comprehensive, employer-provided plan today; they might barely cover the premium for a high-deductible, catastrophic policy, leaving people exposed to steep out-of-pocket costs. And the subsidies wouldn’t be means-adjusted except for the poorest families who qualify for Medicaid. So a family earning $40,000 a year would receive no more help paying their premiums, deductibles and copayments than a family earning $200,000.

Both GOP proposals say they want Americans who are happy with their employer-provided plan to be able to keep it. But watch out for the T-word. It’s not clear what would happen under the PCA if workers got a refundable tax credit and for the first time faced taxation of their health benefits.

Younger, healthier employees might well take the tax credit and buy their own relatively cheap individual policy, leaving employer plans with older, sicker workers who are more expensive to cover. That might lead employers to drop their benefit plans, forcing less healthy Americans into the individual market where coverage would be costlier and harder to get.

And let’s not forget it’s always dicey for a Republican to support a new or higher tax, as John McCain learned last year and George H.W. Bush found out in 1992. How many Republicans in Congress would really vote for this?

Insurance Market Reforms

With their refundable tax credit in hand, under the PCA individuals and families could buy a private policy through state-run health insurance exchanges. Benefits offered in the exchange would have to be comparable to those in the Federal Employees Health Benefits Program. An independent board would adjust payments to plans based on the health status of their enrolled population, so there would be no incentive to cherrypick healthier subscribers. And plans in the exchange would have to offer coverage to all comers, regardless of age, health status, or preexisting conditions. That  sounds good on the surface.

But health plans would be highly unlikely to participate in the voluntary exchanges under those terms. As the health insurance industry made clear to the Obama administration, its strict condition for agreeing to accept everyone without preexisting condition exclusions or waiting periods is that all Americans must be required to buy insurance. Otherwise people could buy coverage at the point when they know they need care, which is a completely non-viable business model for health insurers.

But unlike the Democratic legislation, the PCA would not mandate everyone to have coverage. “If individuals do not want health insurance, they will not be forced to have it,” the bill summary states. No mandate, no serious health plans offering affordable premiums will play.

The HCFA bill, which would not establish health insurance exchanges, has an even more problematic approach to ensuring that everyone has access to an affordable plan. It would allow interstate sales of health insurance with widely varying benefit levels, theoretically giving people more plans to choose from. To insure people with pre-existing medical conditions, the federal government would give states block grants to create “innovative” coverage models, such as state high-risk pools.

But state regulators, Blue Cross Blue Shield plans, and consumer advocates long have opposed interstate sales of health plans because of the history of fraud, abuse, and consumer ripoffs with such plans. Such a system also could encourage cherrypicking of younger, healthier subscribers, driving up the cost for less healthy people. And states’ experience with high-risk pools has shown they don’t provide quality, affordable coverage and they require heavy public subsidies.

Health Services Commission

The Republicans have warned darkly about supposed Democratic plans to establish a national board that would “dictate” and “ration” medical care. The White House and House Democrats have agreed on language to establish an independent Medicare payment reform commission. But no board to limit care or coverage exists in any of the Democratic bills.

Surprisingly, the PCA would establish a five-person Health Care Services Commission, appointed by the President and modeled on the Securities and Exchange Commission, to publish and enforce standardized health care quality and price information. It would be assisted by a 15-person Forum for Quality and Effectiveness. The commission’s job would be to improve the quality of care by disseminating information on effective care and on the costs of care.

The Commission would have authority to require health care providers to comply with the guidelines and standards, wielding the threat of civil monetary penalties and exclusion from federal health programs for non-compliance.

Now, there’s certainly a good policy argument for a strong federal board to oversee quality and cost improvement efforts. But what would Betsy McCaughey and Sarah Palin — who generated a firestorm of controversy with their unfounded charges of government-dictated care and Obama death panels – have to say about Sen. Coburn’s powerful medical commission? I’d like to see Coburn field those questions at his next town hall meeting.

Medicare and Medicaid Changes

Another major Republican attack line on the Democratic bills is that they would cut Medicare and sharply limit care for seniors, ignoring the significant coverage enhancements the Democrats are offering. But the PCA offers its own radical cost-saving nostrums for Medicare and Medicaid, including higher premiums for wealthier seniors.

In 1995, the GOP-controlled Congress passed a Medicare overhaul that would have capped spending and given seniors vouchers to buy a private plan. The bill, vetoed by President Clinton, would have transformed Medicare from a defined benefit to a defined contribution program, placing seniors at risk of rising out-of-pocket costs.

The PCA resurrects that model for poor people on Medicaid, and lays the groundwork for the same type of program for Medicare.

It would give Medicaid-eligible families a debit card worth up to $5,000, on top of their refundable tax credit, to pay for private insurance and out-of-pocket health costs. The combination of the tax credit and debit card still would not cover the average cost of a comprehensive health plan.

For Medicare, the PCA would establish a system of competitive bidding among private Medicare plans, rather than having the government set payment rates for each geographic area. Beneficiaries would pay no premium for the lowest-bidding plan in each area that met program standards. Plans would set their benefit packages accordingly. The clear purpose is to expand private plans and shrink traditional Medicare.

Competitive bidding is a worthwhile idea. But it would require close regulation of the quality, adequacy of benefits, and affordability of the plans being offered, and tight scrutiny to prevent insurers from cherrypicking healthier subscribers. Plus, federal reimbursements would have to remain adequate to prevent seniors from facing rising costs.

Politically, however, the health insurance industry has strongly resisted Medicare competitive bidding in the past. And this model could readily be portrayed as an effort to squeeze care for seniors.

Finally, the PCA would save $30.6 billion over 10 years by making Medicare-eligible individuals earning more than $85,000, and couples earning more than $170,000, pay more for their Part B and Part D premiums. The bill calls this “reducing government handouts to wealthier Americans.” While there are good arguments for greater means-testing of Medicare benefits, how will the Republicans’ base of older voters respond?

The Republican bills show that thoughtful conservatives recognize there are major problems with the current U.S. health care system — and that addressing those problems requires difficult political choices and big changes in how Americans get coverage and care. Their proposals need to receive the same public scrutiny as the Democratic proposals are getting, so the American people can see there are no easy answers.

Let’s hope that over the next few months, Republican lawmakers publicly acknowledge the tough issues they’ve tried to grapple with in their own proposals, and join with Democrats in a more constructive process to pass needed reforms.

Harris Meyer is a veteran health policy journalist based in Yakima, Wa. He’s a past winner of the Gerald Loeb Award and the National Institute for Health Care Management journalism award.

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  1. I wish to also give a great big thank you to the People of this site for helping FASC Concepts to become the largest web site in the USA and is fast becoming a leader for a honest Health Care Reform. and at the same time to bring a reform into our Government where a Unity is lost for a Leadership.
    Preexisting Conditions
    To help cover the sick and the poor is a FASC Concept that states that to build a Health Care Forum within our Government Institution is a Peoples right to do so and this is Protect Under the Constitution as a Human and Civil Right. So in plan words if the poor and the sick could only afford to pay $5.00 to $10.00 per month this would to bring a balance toward the broken tax system, to add up this number 32 million to 100 million sick and poor people x $5.00 per month. This will place back into the system $116 million $to 500 million dollars per month. The cause and effect of this will reduce the purposed Health Care Tax Forum, to bring about a reduced effect so not to a over  burden system. Take my faith in this and almost all the poor and sick would be happy to pay in and help rebuild the United States failed tax system. Also To bring about a balance of trust lost between the people and Officials.
     Under a Federal Health Care Group built by my friends and I. {You see the poor, as you see them}, as for them they see them self not poor, but of a different race of people and environment and have faith it that which was in the past that so many do not have a clue of what God and Country is all about.
      Will be up dated today  3/25/2010
    Issue 1.
    FASC tax and pay in Forum, A Concept to help the Poor and Sick.
    FASC Concepts of a guideline of income and a fair payment for the poor to the rich.
      CLASS                                            INCOME                                                    MONTHLY PAYMENTS
     {A} formatt for people making up to $29000.00 per year, EST of monthly cost up to $40.00 per month
     {B}                                       up to $19000.00 per year, EST of monthly cost up to  $30.00 per month
     {C}                                       up to $12000.00 per year, EST of monthly cost up to  $20.00 per month
     {D}                                       from 0.00 income to $9000.00 per year /   cost up to 0.00 to $10.00 per month
                                                                                 MIDDLE CLASS TO THE  POOR
     {A} {B} {C} {D} classification based on one person If married policy can be devided or stayed. These are concept numbers to open the mind…………..
      Submitted by Marh Hidabrand,asked would it not be better to build on , instead of droping off of the {A}{B}{C}
     {E}                                       up to $49000.00  per year,EST of monthly cost up to     $50.00 per month
     {F}                                       up to $59000.00  per year,EST of monthly cost up to      $60.00 per month
     {G}                                       up to $69000.00 per year,EST of monthly cost up to       $70.00 per month
     {H}                                       up to $79000.00 per year,EST of monthly cost up to       $80.00 per month
     {I}                                        up to $89000.00 per year,EST of monthly cost up to       $90.00 per month
      To balance a payment plan to fit within the bills, within a home……….{J} {K} {L} {M}     exc………………….
      Need to balance to stay around $200.00 for above income and below $300.00 for the rich ?
      The same incentives apply if husband and wife who wish to pay separate. See incentive concept for FASC , a concept that builds for the children for tomarrow.
       The same incentives apply for the poor, even if all they can pay is $3.95 per month. No one is cut out of the rebuilding of the inter structure of Health care and the USA.
      The money is a investment into our further and is to be tax free, just the money paid in.
     
     You may ask: what about Medicare ? {is it not possible to merge Medicare into this concept ?}
     With in this movement the {A} {B} {C} {D} will remove health care from a company so that  a company can see into the building of other projects and put people back to work.
      With the formatted goal of the use of this new concept, to form a more perfect Union within the design of the Health Care program offered, we submitted the up to 2 Trillion dollars per year. This will build a safety net / a buffer to maintain balance.
      The  billion dollars per year is at a high EST. based at $10.00 x 250 million people. As you can see the numbers above suggest a very high in pack of funds, we can not project a high in pack because dollars are not a constant.
    at 100 000 000 million people x 10= $1 000 000 000   billion low ball figures
    1 billion x 4 weeks = $4 billion dollars
    4 billion x 12 months = $48 billion dollars
    so at 100 000 00 the numbers would have to increase to $40.00/per month x $40.00
    $40.00 x 48 000 000 000 = $1 220 000 000 000 per year at 100 000 000 people
    In the US the progression is:
    Hundred – 100
    Thousand – 1,000
    Million – 1,000,000
    Billion – 1,000,000,000
    Trillion – 1,000,000,000,000
    Quadrillion – 1,000,000,000,000,000
     and the interfacing of the FASC Card  http://www.federalactsecuritycard.mysite.com
      We need to see into the inter structure of the Presidents concept,without this right we can not help,no matter how much we wish to. It would seem that if you do not play follow the leader on just one concept ,that the door is not really open.
      We offer the following concepts and we believe that it will be one that all can respect. 
      We need to see into the inter structure of the Presidents concept,without this right we can not help,no matter how much we wish to. It would seem that if you do not play follow the leader on just one concept ,that the door is not really open.
      We offer the following concepts and we believe that it will be one that all can respect.
      A FASC Concept, Children should be covered by moms or dads coverage at no extra cost. I once heard that their was a saying that is within the Christian world, it is in the best of man that through a concept of God, that He smiles on those who help the poor. Now this is your faith, as shared with people.
     
    Is There A Constitutional Infringement of a Moral Value for Health Care vs. The People
    Part 1: 3/22/2010: { recapped for short input}
    I had to wait for this Bill to be passed in order to show the Republican Party, GOP and FRC Action that it is the voice of the people that guides the destiny of this Country. I guess you could say I needed them to get out of the way so that the last Comic Standing will be FASC Concepts and we do not need the peoples money to assist the needs of the Peoples Rights.
    As predicted , the first stages of the Health Care Bill was passed. Why, you ask ? It is because people wish to be seen for their in put of a view and not unite. What is lost is respect with in a concept of { Freedom Of Choice } to be a part of this system or not, with in this Health Care Force Pay Matrix.
    What is offered by FASC Concepts is the Freedom Of Choice, because we feel it is unconstitutional to force pay into the failures of Health Care Insurance Companies and then Tax that money. As you can see our elected officials are paying little attention to the public. As I reach out to my computer and I knock , knock, knock on the screen, and I say is there any body out there?
    You will not find any lies posted that is not clarified…..
    You can find the details on p23. At the link site for http://www.thebluepill.mysite.com on page 100 at the main site.
    FASC Concepts in and for Pay it Forward covers the web see why we have become the Largest web site in the United States, join us in a trickle effect on p23 the blue pill link, ?
    on google , yahoo, and aol http://www.fascmovement.mysite.com

  2. I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
    Patricia
    http://dataentryjob-s.com

  3. Democrats have complete control. Republicans cannot offer bills that the democrats do not allow them to offer. They offered hundreds of amendments which were voted down and the press did not report each of them most of which would have had strong polling support of the american people.
    So if they pass this mess and the economy blows up big time and unemployment rises, there is only one party to hold accountable.

  4. seeing as they get 2/5ths of the service for only half the cost they could do better. They do turn out some beautiful women though so I would be willing to try it. I’ll back my bags and engage in some submursive research and let you know how good it is.

  5. Don’t be so hard on yourself Nate. I was laughing…
    My deepest apologies to the Aussies… again. BTW, how do you feel about the healthcare system down under? It seems to cost about half as ours…..

  6. Depending on the size of the client and exactly what we do we charge our self funded clients $10-$20 Per Employee Per Month(PEPM). If they buy PPO access and UR services add another $5.
    Carriers charge roughly $50 to perform the same work.
    Fully insured plans pay roughly 3% state premium tax. Premiums I see run around $300 single and $800 family. Premium tax alone runs $9 to $24 PEPM.
    Government pays administrators roughly $21-$24 Per Member Per Month which is almost twice what we pay, groups average a little over 2 members for each employee. They get a fraction of the service though. They pay for auto adjudication with no auditing at all. We have adjusters review every claim with zero auto adjudication. Thay also take member customer service calls. Government insurer pays more for admin plus gets ripped off on what they do buy.
    Avoiding mandates can save up to 50% or more for some groups. We have had clients go self funded specifically to avoid a state mandate.

  7. We’ve certainly got a lot of players trying to belly up to the trough.
    Nate, I seem to recall hearing you say somewhere that you have had some involvement with self-insured employers. I read that 55% of employees who have employer-provided group health insurance are covered under their employers’ self-insurance plan. In trying to get a handle on this “administrative costs” issue, it occurred to me to wonder if the savings realized by these self-insurance arrangements would not provide a reliable clue to the savings a govermental insurer might be expected to realize. I’ve haven’t happened upon any persuasive data here. Most of the discussions talk about savings through avoiding state premium taxes and mandates (you know, in-vitro fertilization and the like.) Do you have any thoughts on this head?

  8. thats why I usually don’t try to be funny margalit, only I end up laughing. Your cold hearted attack on the aussies was the rare exception.

  9. i was sarcastically saying the bills being proposed with premium subsidies and public options are not attempting to contain cost or improve care. Your right that nothing that would actually improve cost and care is dependent on what is in the reform bills, the reform bills use them to justify the public option more handouts.
    In another post I mentioned how some states already have successful co-ops and we don’t need a federal bill costing a trillion dollars to copy those. But the left hopes they can use them as an excuse for a trillion dollar bill.

  10. I really don’t care what the “insurance industry” supports.
    Not sure I follow the drift of your first paragraph, Nate (I’m a little slow) but I wonder if effective “cost-control” systems will not inevitably lead us to a hornets’ nest: “interference in professional judgment.”

  11. “It is not readily apparent why an analysis and evaluation of provider practices, and the development of cost-control systems, should be dependent on embracing the “public option” and massive premium subsidies.”
    archon41, the insurance industry supports “massive premium subsidies”, as opposed to massive premium controls. I’m actually for single-pay, but if a public option gets us there then that’s ok. This money driven system will not rein itself in and only big stick budgets and price controls will get it close to cost sanity.

  12. if all you really care about is the trillion of dollars an HC takeover would give you doing an analysis and evaluation of provider practices, and the development of cost-control systems for free would suck. These politicians in DC doing all this work “on our behalf” deserved to be richly paid.
    If you look at the history of reform going back to 1965 or even to 1906 when the Democrats first started proposing taking over healthcare it really is clear they never cared about improving healthcare just controlling the money. Their 2009 solutions are exactly the same as their 1906 solutions. There never was a problem until they starting fixing it.

  13. One drop of Chateau Latour all around! Except for Pete. He’s sacrificing for the Greater Good.
    It is not readily apparent why an analysis and evaluation of provider practices, and the development of cost-control systems, should be dependent on embracing the “public option” and massive premium subsidies.

  14. Gary,
    Single payer overhead is not lower on apples to apples basis, if you do less you can spend less doing it, that doesn’t mean it is cheaper. Medicare is far more expensive then private insurance to administer as proof that single payer is not cheaper.
    While it is nice to budget savings from preventive care no study or trial has ever shown actual savings. Preventive care improves health not finances. In fact, by helping people live longer you actually increase the amount of health care they consume so you in fact increase cost. Most people believe the improved life is worth the cost but it disproves your claims there will be savings.
    Your just repeating political rhetoric, nothing you say has any basis in fact. For profit insurance companies have done a far better job treating chronic conditions then Medicare, again disproving your claims.
    Jake,
    Great points just need to clarify they apply to the federal government. If states wanted to try this whacky socialized medicine ponzi schemes by all means go ahead, a la Hawaii. We have the ability to move out of a state engaging in behavior we don’t approve of. We shouldn’t be asked to leave our country because the federal government tries this crap. This is exactly what the narrow defined role of the federal government in the constitution was meant to protect us from.

  15. DrWonderful. That’s exactly what Joe Paduda is referring to! These people who are fighting against health care reform better not complain when they can no longer afford their health insurance, or their employer can no longer afford offering health insurance, and the economy continues to sink under the weight of health care costs.

  16. “I assume you read the articles last few days about France and their financial woes in regards to HealthCare?”
    Nate, they know the reality of sustaining a vaible economy to provide social services, how many people here find the private economy has eliminated their ability to pay for health insurnace. Why don’t you get over there and show them that your high deductible plans will save their system? I guess they just need their risk “managed” better.

  17. archon41 wrote:
    “We should be discussing “adequate” health care for the indigent and uninsurable”
    Death panels?
    “I am a college student, and don’t have a lot of money”
    Jake, got health insurance?

  18. btw, I am a college student, and don’t have a lot of money, so don’t accuse me of being rich or anything like that lol…

  19. Say no to socialism! Nowhere in the constitution does it say any American is garaunteed anything without proper payment except our inalieble rights, in which healthcare is not one of those, especially if their care is at the expense of other, prosperous people.

  20. These are all valid points, but what everyone needs to realize is that you’ve all been brainwashed! Yes, indeed you have; American government is supposed to protect the constitution and defend us from enemies, not take control of important, free-market systems. When the government takes control of healthcare, and this goes for both the Republicans and Democrats’ plans by the way, yes it will be socialized medicine, yes, the quality of care will decrease, because of no competition with insurance and losses of quality doctors, and again yes, the government will have access to personal bank accounts through this bill, and yes, it will cost trillions of more dollars, and no I don’t condone all of Bush’s actions either. However, this bill will ruin American healthcare/medicare as we know it. But back to my point about Americans being brainwashed…this is a country that was founded on equality on the grounds of equal OPPORTUNITY, NOT EQUAL WEALTH or HEALTHCARE. Promising everyone the chance at healthcare or certain level of care from the government is called socialism and can even borderline communism at times. IT DOESN’T WORK, AND IF IT DID, IT WOULDN’T WORK IN AMERICA ESPECIALLY. Somebody show me where in the constitution it says anything about every American having the right to healthcare, even if it is at the expense of other, prosperous people. This brainwashing has taken away from REAL American values and the American Dream, which is truly based on big business and personal success, but not government mandates. Don’t me call stupid just yet, just read on, cuz I have an important point here: the liberal media and neo-liberal/socialist universities/textbooks are teaching people to think that we all have the “right” to anything…To a certain extent, yes we do, but on the other hand, everyone having the right to healthcare comes at a huge asking price. People need to keep that all in mind when they automatically go and support their party’s plan.

  21. Nate, do you mean how does single payer address the skyrocketing health care costs? First, the overhead is lower. Secondly, providing care to currently uninsured patients before they require high-priced hospitalization. The answer is not to deny people needed care, but to get them the right care at the right time. Thirdly, by making health care providers accountable to give the correct care to every patient, especially those with chronic conditions. Seventy-five percent of health care costs are spent on patients with chronic conditions; 80 percent of those costs are consumed by patients with two or more chronic conditions. The five major chronic conditions that drive the vast majority of health care costs in this country are asthma, congestive heart failure, depression, coronary artery disease and diabetes. A Commonwealth Fund study estimated a 25 percent saving, or half a trillion dollars per year, (other studies estimated more) just by bringing all caregivers in the country to the cost-effectiveness levels of the best performing regions. For-profit insurance companies have no incentive to hold providers accountable for cost-effectiveness.

  22. We would hope the proposed SEC like medical care governing board (“Health Care Service Commission”) does a better job than the SEC did with complaints about Madoff.
    Neither the Dems nor the Repubs demonstrated knowledge that they grasp the genesis of the “broken” system. Without that knowledge, any proposal or bill to “fix”
    it will be tangential…and all are just that.
    Coburn is an MD. He should know better. He should be talking to the docs taking care of the patients, PCP and Specialists.
    Where is the tort reform and where is the engagement to improve cost effectiveness?

  23. Well, Gary, I appreciate your attempt to enlighten me, but I’m not sure you have negated my concerns about the proposed ways of responding to the needs of the indigent and uninsurable. I would here have reservations, even if it could be demonstrated that the “public option” would substantially reduce the price of insurance. I don’t believe it can, and I have dutifully trudged through many a discussion about insurer profitability and “administrative costs.” Hopefully, I will not give great offense by saying that some advocates of “single payer” occasionally give the impression that they are cult followers of Michael Moore.
    Dr. Atul Gawande’s study of provider costs in Mcallen certainly raises some issues. I don’t know that I have seen a plausible refutation of his conclusions. At the same time, I would suggest that the issues he raises can be addressed independently of insurance subsidies and the “public option.”

  24. So what happens when we get single payor and 15 years later it is bankrupt and collapses like all other single payer does, then it is back to private insurance? I assume you read the articles last few days about France and their financial woes in regards to HealthCare? There is an article every day out of the UK and their problems. Why should we trade our problems for worse single payer problems?

  25. Greg- why will health care premiums jump so much. with co-pays and deductibles rising rapidly while payments to doctors are sinking fast…how can they justify premium raises. Where’s the money? We’re now seeing $45 co-pays on an office visit that has a $58 contracted fee. . Meanwhile the HMO is sending a check for $13 while patient pays $45. All while their premiums go up? Please! That same service used to be reimbursed at $85 with a $20 co-pay just 5 years ago. What planet do you live on?

  26. Joe Paduda, at Managed Care Matters, reminds us that health benefit costs will jump (again) more than ten percent next year. When costs increase ten percent a year, they double every seven years. With current family premiums in the $15,000 range, employers and employees will be paying $30,000 per family by 2016. And that’s not including deductibles and copays, which are sure to rise.
    When enough Americans lose their coverage, when cost-shifting gets to the point where those left with insurance are paying thousands in premiums to cover those without, when local taxes to pay for teachers’ and police benefits get so high that folks are losing their houses, when Medicare finally goes insolvent, when hospitals are collapsing due to the cost of indigent care, when big pharma and device companies are no longer making the gazillions they so richly deserve, then, and only then, will the screaming hordes at Town Hall meetings decide that any health care coverage is better than none.
    What happens then? We’ll end up with single payer, or Medicare for All. The false patriots championing freedom and the American tradition of independence and all that other hooey will find themselves drowned out by the moms and dads desperate for insurance to cover their kids and parents.
    Unlike the distortions, misrepresentations, and outright lies being spread by McCaughey, Limbaugh, Palin et al, this is the real deal. So fight against reform if you wish, but don’t complain later when you can’t afford insurance, your employer can’t afford insurance, your taxes are going up to pay for teachers’ benefits, and our economy is sinking under the weight of health care costs.

  27. archon41: One of the main points of this post is that even such arch-conservatives as Senators Coburn and Demint get it: by changing the way we deliver health care we can drastically reduce the cost per person while at the same time increase quality. While both of their bills (S.1099 and S.1240)are woefully inadequate to effect reform, they amazingly call for heavy-duty regulation of hospitals and doctors, to wit, the creation of (1) a new agency that would recommend to the Secretary of HHS new guidlines, standard and performance standards for health care providers, and (2) new powers for the Secretary to exclude from any Federal health care program, e.g., Medicare, any provider who does not comply with those standards. This is way more than merely setting up a public option plan to compete with inefficient and wasteful providers. I live in Hawaii, where the average Medicare reimbursement per enrollee in 2006 was $5,311, compared to the US average of $8,304. Check out the Dartmouth Atlas here, where you will find many metropolitan areas hovering at or above $10,000 per enrollee, and McAllen, Texas at $14,946. I would dare say we are as healthy if not more so here in the Aloha state. Why should we subsidize such profligate waste? The serious debaters know that quality will actually improve when the waste and inefficiencies are reduced. Will there be losers? Yes, those who have seen their profits dramatically escalate, while the rest of the economy has collapsed.
    Aloha

  28. “No one has the right to healthcare. Based on what philosophy? If one want’s health insurance they can purchase it. If they cannot afford it then they do not have the right to force someone else to pay, that is called tyranny, stealing via the government.”
    This is a very draconian philosophy and I am much more than willing to bet that if Sabastian or if someone in is family became sick & he was unable to afford it then he would change his tune quite quickly.

  29. Shorter archon41:
    “The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.”

  30. Perhaps I confuse myself, but the crux of the matter seems to me that you cannot give the uninsured and uninsurable more health care without giving the insured less than they presently enjoy. I do not know that I have ever heard any of the advocates for these competing proposals acknowledge this simple, economic inevitability. Perhaps they fear being accused of indifference to humanitarian concerns. Be this as it may, it seems clear enough to me that we can no more make “quality” health care available to all than fine bordeaux. We can try, with rationing, price-fixing and whatnot, but the lag time for, say, an MRI will surely, for the presently insured, grow longer. And what ethical or economic metrics will govern the rationing process?
    Whatever the outcome of this grand debate, I am satisfied that some of us will end up drinking from the jug, and I’m not altogether convinced that that’s not as it should be. We should be discussing “adequate” health care for the indigent and uninsurable, and I wonder how we all got off on the supposition that buying insurance for them is the most cost-effective means to that end.

  31. Harris, I think the main reason that the DeMint and Coburn proposals haven’t been discussed is because they’re non-starters.
    I appreciate how you articulated some details as to why that is, but ultimately I don’t think either was made in good faith or as a serious attempt to address an identified problem.

  32. No one has the right to healthcare. Based on what philosophy?
    Yes, everyone does have a right to health care, and that statement is based on simple ethics and morality.

  33. Sabastian,
    I am a healthcare provider. If healthcare is not a right and you come to me seeking treatment, am I within my rights to withhold it even if you can pay?

  34. Socialism does not work, read history.
    No one has the right to healthcare. Based on what philosophy? If one want’s health insurance they can purchase it. If they cannot afford it then they do not have the right to force someone else to pay, that is called tyranny, stealing via the government.
    People need to think about what they are asking for. Obama is a politician! He has never worked a day in his life. To give politicians power over healthcare is dangerous, immoral, and illegal.

  35. The situation is now very difficult and many people do not really know what to do, but now we must get down to analyze each of us and see if we can get ahead, as everything depends on oneself, there are ups and downs but the important thing is that while there is life there is hope, a few days ago that antidepressants as vicodin, Lorcet are the most common pills used in these cases but not many of them know the consequences…

  36. Good post- What really got to me though were Republicans (some leaders) not denouncing the fearmomgering outright lies that were thrown around by the extreme right wing media and the “crazies” at some of the town hall meetings.
    I cannot forgive them for that.
    Dr. Rick Lippin
    Southampton,Pa

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