Half a Loaf of Health Care Reform

In a core plank of the “Pledge to America” unveiled earlier this month, the GOP leadership of the House of Representatives promised to repeal Obamacare and put in place “real” health care reform. Insofar as Obamacare represents a massive transfer of wealth and gums up the health care industry with over-regulation, it does need to be scrapped, shredded and incinerated.

But the Pledge’s idea of what constitutes reform inspires little confidence that Republicans have a credible alternative to runaway costs and shrinking access to health care. Indeed, the vacuous verbiage of the Pledge suggests that its authors have only the most superficial understanding of what ails America’s health care system and will fail miserably to fix the problem when they take charge of the House next year, as they seem poised to do.

The Pledge’s critique of what’s wrong with Obamacare was mostly on target. The new law will raise taxes and increase costs. Because it will barely pay for itself, if at all, the law does not seriously address the nation’s long-term fiscal crisis. While expanding benefits for some working Americans, Obamacare strips Medicare Advantage benefits for millions of seniors. (The GOP could have broadened its indictment by noting that the “reform” also will discourage innovation and competition by driving many small insurers and physician-owned hospitals out of the marketplace.)

But the Pledge omits any mention whatsoever of a revolution in thinking that has emerged from the health care industry: The way to contain escalating medical spending over the long run is not through traditional cost-containment measures but by bringing productivity and quality up to private-sector standards. It’s as if the Republicans had been put in charge of building the world’s most powerful bomb during World War II and they tried to tackle the job without alluding to nuclear fission.

Let’s cover some of the Pledge’s concrete ideas:

Enact medical liability reform. Congress has largely missed the boat. While Congress dithered, many states have already reformed their laws, with the consequence that the worst abuses have been curtailed. Tort reform might help on the margins, but it will not create the massive savings that congressional Republicans think it will.

Purchase insurance across state lines. Republicans contend that opening up health care insurance to competition across state lines will allow consumers to buy lower-cost plans with fewer state-mandated requirements from insurers in other states. State mandates are a very real problem. But if this reform were enacted, the medical lobbies would simply shift their attention from state governments to Washington, D.C. Over time, mandates would become national in scope, obliterating the pockets of lighter regulation that now exist.

Expand Health Savings Accounts. HSAs do encourage enrollees to exercise more care as consumers: buying generic drugs, using urgent care centers instead of emergency rooms, shopping for the best deals on labor and delivery, and the like. But those savings apply only to the simplest and most routine of encounters with the health care system. Americans lack the information to make intelligent consumer choices based on price and quality of care for cancer, heart bypass surgery or even the treatment of chronic disease like diabetes or kidney failure, which account for the bulk of health care spending.

These ideas may do modestly more good than harm, but they will fall far short of transforming the healthcare industry on the sweeping scale that the country needs to avert fiscal calamity. Congressional Republicans have failed to articulate a vision for entrepreneurial, market-driven change as an alternative to Democrats’ vision of bureaucratic, top-down reform.

One last point: Obamacare has enacted a component that is essential to evolving a market-driven health care system: a mechanism for collecting and publishing medical outcomes data. Patients cannot exercise informed consumer choices without knowing how hospitals and doctors compare in the quality of the care they deliver. It will take years to put this mechanism into place. It would be insanely self-defeating for Republicans to scrap this and other productivity/quality initiatives in their zeal to repeal Obamacare. But the hatred of Obamacare burns so fiercely that congressional Republicans appear likely to indiscriminately jettison the good with the bad.

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9 responses to “Half a Loaf of Health Care Reform”

  1. Here's the fundamental issue. Should the Federal Govt be involved in health care?

    If your answer is "no" – then you are done and my impression of the Republicans and Tea Pots is that is indeed their position.

    So if that is your basic position and you are suggesting "things the Feds can do" WTF is that?

    I say this is hypocrisy.

    If you believe the govt should not be in HC – say so – stand on that – and submit yourself to the verdict of the voters.

    Otherwise – you're playing stupid and dishonest word games intended to deceive and fool people who are on the fence but realize that private HC is a monumental failure not that different in concept to the payday loan business – only much bigger, much more pervasive and predatory.

    If you do believe the govt should fundamentally be involved in HC then you have adopted a Democratic position and sworn off the core Republican ethic cynically exercised as a fan dance to fool the clueless middle into voting for you by telling them that you DO believe in the Feds being involved but won't do the deed.

    The Republicans had 8 years under Clinton and 8 more under Bush to put their imprint on what HC should be in this country and unless you want to believe they are a bunch of incompetent fools – they have ALREADY SPOKEN on the issue and now we're playing stupid word games.

    I say this.

    Stand up for your principles and be man enough to tell the truth and abide by the verdict of those you seek to govern.

    If you can't do that – you're not worth WARM SPIT!

    I can further elaborate on my views on this if they are unclear to anyone.


  2. Do folks realize why EMTALA – the law that requires hospitals to treat ER patients for free has not been advocated for repeal by the Republicans?

    Remember – this is the law that allows the ERs to perform primary care through end-state treatment at rates 3 and 4 times higher than non ER rates – and then cost shift them onto the bills of people who have insurance which in turn lets the insurance companies increases their premiums and get rid of "costly" subscribers.

    The answer is the same as it was Medicare Part D.

    In both cases – in a word – it is very profitable for the drug and HC insurance companies.

    Republicans do what they can for "businesses" and the HC industry is no exception.

    We pay 5-10 times more for the same drugs that Europeans and our own VA pay – why?

    We pay twice as much for HC per capita than Europe and Japan and they have longer life expectancies – why?

    Is this something that govt should be involved in?

    The Republicans will fundamentally assert that this is the free market at work – and that if the govt gets involved with it – it will screw it up….

    Like I said – the Republicans had 16 years to do "something" and they did absolutely nothing other than Medicare Part D – a govt-subsidized give-away to Big Pharma.

    The Republicans have a track record.

    They are now playing games by asserting they will REPEAL ObamaCare and replace it

    … with what?

    well.. will what folks Jim Bacon are "suggesting" … uh huh… .

    once more – the Republicans are fundamentally opposed to the govt being involved in HC even if they won't be honest and admit it – they have a record that proves it.

    what exactly would you expect in the way of REAL SOLUTIONS from folks who are opposed to the govt "interfering" with private industry HC?

    I cannot believe the American people buy this crap from the Republicans..but they do.

    What the Republicans have learned is that Lincoln was not totally correct.

    It IS POSSIBLE to fool all the people all of the time if they are the clueless middle who substitutes sound bites for critical thinking …which makes sense because that's the big failing of our schools these days.

  3. Gooze Views Avatar
    Gooze Views

    In general, Jim's critique is reasonable, but I keep coming back to one essential point: OK lots of people dislike ObamaCare but it is the first real step in the right direction in decades.

    Managed care, which sought to contain costs and limit physicians' discretionary spending brought us an oligarchy of big insurance companies who took it upon themselves to throttle the healthy and deny care for the sick so they could make a profit. Ever try to get care if you have a "pre-existing condition" defined of course by whatever the insurer's underwriter says it is?

    Unde this system, you may pay in perhaps a coupel of hundred grand over years and maybe take out perhaps $30K which is great deal for managed care. If you lose employer-based group coverage in a lay off through no fault of your own, the same insurer whose bottom line you have so contributed to no longer wants you. You are screwed. At least ObamaCare puts and end to this by 2014.

    Conservative pallatives such as selling across state lines and HSAs are non-starters. Without proper regulation, the same insurers will just get bigger markets and divide them up amongst themselves. The same set of converage issues will remain. The "magic of the market" envisioned by Bacon and hgis fans is a delusion.
    Bacon, however, is right that HSAs can't work until people are well versed in costs and choices. Guess what? Many vendors and companies offering coverage don't know what the costs are. Ever try to get someone to break down an estimate for, say, therapy for an elderly person? You have to go through a number of bureaucrats and still don't know.
    So Jim may like to talk about "productivity" all he wants but it's hard to see how you can measure productivity when you don't even know what the prices are since they are established by non-transparent and private dickerings between insurers and companies.
    Final thought: as my late father, a surgeon, used to say, "People are all different. No outcome is the same." So, you can't apply the same analysis that you can for jet engine manufacture to human beings. Simply stupid.

    Peter Galuszka

  4. yes.. the bottom line here is that Republicans are fundamentally opposed to the govt being involved in HC – from the get go.

    And the stuff they say that "could be done" – well..

    that stuff is fundamentally opposed by most Republicans and that's why they stay …. "ideas".

    These guys are NOT going to fix HC.

    As bad as some think that Obama_Care is – it a step in the right direction and can be tweaked and altered…

    the SAME WAY that Medicare and SS have been – over the decades.

    Remember who opposed Medicare?

    Remember who opposed SCHIPS?

    it's the same folks who are opposed – not only to Obama-Care but any/all HC where govt is involved.

    this should not be rocket science.

    the average person does have a brain and a memory and can go back the last two decades and see exactly what 'reforms' that the Republicans have supported.

    I'm totally exasperated by the folks who oppose Obama_Care and at the same time – have no clue what the Republicans are NOT going to do.

    the nation has collectively taken a double dose of stupid pills.

  5. Health Quotes Avatar
    Health Quotes

    We won't see a repeal, but perhaps a defunding. Some of the bill makes sense, but you just can't force health insurers into bankruptcy. State high risk pools and more utilization of HSAs might be a starting point.

  6. is this a "govt" approach ?

    I'm still thinking that the Republicans are fundamentally opposed to any govt involvement as opposed to a "different" govt involvement.

    At the end of the day – the "ideas" are like fruit flies the day before the frost.

    Next morning – all those ideas are gone – and the bottom line is the Republicans not only don't have any ideas but they oppose any other also.

    This is the problem.

    If the Republicans would actually put together a legislative agenda – it would undoubtedly pass – as it would have in previous years and would have served as a preemptive action that undermined any Democratic approach.

    We still come back around to the fact that the Republicans are not really offering anything more than stalling tactics and the clueless middle does not have a clue that this is really what is going on.

    Paul Ryan has as one of this points on his blueprint:

    " * “eliminate the income and payroll tax exclusions for employment-based health insurance”;"


    that's an HONEST PROPOSAL ..

    guess how many other Republicans have signed on to that in their "pledge" to REPEAL & REPLACE?

    answer – no one.

    The Republicans are the quintessential Lucy's with the football and the clueless middle are the Charley Browns.

  7. Anonymous Avatar

    As I've posted previously, I think Obamacare creates too many perceived losers (i.e., those who are worse off) for the number of perceived winners.

    Also, it's been my experience that government does not make as good of economic decisions as the marketplace. I've heard confirmation of this by government officials, both Democrats and Republicans, for as long as I've been in the Washington area.

    I will agree, however, that government has a regulatory role to play, which can work or not. Regulations should be focused on areas where the public health, welfare and safety are involved, be reasonably and narrowly tailored to address real issues; and fairly and transparently administered.


  8. Larry G Avatar

    well the word "perceived" is a key issue and it appears that it all boils down to the folks that have – fearing that a system that accords to those they don't have will hurt them.

    No other industrialized country in the world has this problem and no one in any industrialized country is prevented from paying to get more/better of anything including health care.

    so it appears that the folks who have health care – don't believe they could do better on their own so they are purely opposing others to preserve their own self interests – even if in the longer run their own kids might not be able to get health care.

    As far as the private sector doing a better job – where is the evidence of this when it comes to health care?

    The costs have doubled in the last decade or so and projected to double again.. and more people will be tossed and other denied coverage while virtually everyone is going to pay higher co-pay and deductibles.

    If the private sector did such a good job – we'd get rid of Medicare – right?

    Isn't this a simple denial of the realities which includes anyone who believes that the Republicans are committed to any form of health care to start with and play word games on the issue to fool those in the middle who are apparently unable to look at the plain evidence of the Republican role in health care.

    All I ask is that folks be honest about this.

    The Republicans be honest and the folks who believe in the Republican approach be honest – and then let the voters made their decisions.

    We can't have honest debates anymore apparently.

    Why not both sides say what they are in favor on – and stand up straight and look the voters in the eye – and abide by their decision?

    The Republicans would be burnt toast if they told the truth.


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