The Future Challenge of Republican Health Care Reform

[Mr. Right-of-Center]

I definitely don't like the health care reform bill passed by the House of Representatives.

I'm making an educated guess that I won't like the “watered down” Senate bill either.

And assuming passage in the Senate, I suspect I will not like the combined conference bill that finally emerges for the President to sign.

That is no surprise because I am a Republican with definite conservative economic views.

But, this is not the apocalypse. This is not the end of mankind or civilization.

It is difficult for me to see that the legislation as I understand it will bring health care costs down, not raise taxes during a severe economic downturn, not raise the deficit, and not cover illegal aliens in some way...

So I find it hard to see that this bill is really going to bring substantial improvement to the health care crisis.

But the inflamed rhetoric opposing this legislation probably is not in any way helping the Republican party. Word for word, much of it is identical to conservative opposition to the New Deal, Social Security, Medicare, Medicaid and the the Bush Drug Benefit.

To hear Republican opposition to this single piece of legislation, one would think that it is the end of the Republic itself...or, as one inflamed Congressman stated “This bill is more a threat to American security than Al Queda or a terrorist attack.”

Very purple prose...but I think that Congressman can safely oppose the bill, continue his duties to his district and not worry about personal harm if this bill passes. I don't think he would be quite as unperturbed if we had another 9/11 event or worse...

At least a part of getting a very bad Democratic bill on health care is the fact that the Republican party has not seriously addressed the issue since Richard Nixon proposed an employer mandate to provide insurance in the early 1970s. Believe it or not, Nixon's efforts, which were not too different from some aspects of the current bill, was dramatically opposed by Ted Kennedy because he wanted a single payer government health care system or nothing.

And owing to the great foresight of Ted Kennedy, the American people got no health care reform in the 1970s. Of course, his enthusiasts don't dwell on that lapse in his judgment.

It is true there has been a late entry of a Republican health care bill introduced this past week in the House. But it is very late in the game, not really a comprehensive proposal, unlikely to have any impact whatsoever on the legislation that finally gets passed, and largely serves as a band aid for Republican office seekers in 2010 so they can claim there was a Republican alternative.

This health care reform effort will not bring about socialism. It will not subvert the American economy or government system. It is not gloom and doom.

What is disappointing is that it's not going to lower health care costs significantly. It is going to increase government bureaucracy. It is going to lead to some form of higher taxes. It is almost certainly not going to be deficit neutral.

It is going to create more problems in the short and long term than it is likely to solve.

So I would propose a practical solution rather than predicting apocalypse.

Continue all efforts to lobby for a better bill in the U.S. Senate.

In conference, there is very little that can be moderated by the Republican members of Congress.

But when and if this legislation gets to Obama's desk for signature, Republicans have to begin thinking about ways the party can address health care reform from a private market approach...and how the bad legislation we are likely to get stuck with can be revised and reformed in later years to privatize and streamline as much of its actual administration as possible.

I don't think it is conceivable that we are going to be able to turn lemons into lemonade, but health care for all Americans has got to be a central policy objective of a Republican platform going into the future.

I am convinced there are better ways to bring health care costs down and provide better health care to most if not all Americans without a huge new government entitlement program.

I think it is up to Republicans to start thinking and planning how that will be done going into the future.
Because I think we can all be certain of one thing: the big spending Democrats are never going to be seriously looking to make the health care system in this country more private market efficient...just the opposite.

This is a serious new objective for the Republican party.

[Whitehorse (Robin Ray)]

There will still be 17 million uninsured under the Democrat "plan" - it's not about health insurance or health care reform; it's about control over our choices.

[Jim Rock]

I dont think the opposition is so much about health care--its about re writting the duties of the Govt that has panties twisted real hard.

read an article yesterday that this year there has been $48 milll in fraud in Medicare , well why did this money get sent out if its fraud? If this New govt cant stop 1 program from getting fraudulent funding how are they gonna oversee an entire piece of the American economy

[Vek]

I hope that i never get sick if this universal health care passes.

[Whitehorse (Robin Ray)]

I think that we can survive such a program & the trouble it would take to get rid of it. I do also think it would be better to avoid it if possible. The child can survive burning his hand on a hot stove eye, but the recovery is nasty & the scar is forever...

[Evelio Perez]

By Mitt Romney

Because of President Obama’s frantic approach, health care has run off the rails. For the sake of 47 million uninsured Americans, we need to get it back on track.

Health care cannot be handled the same way as the stimulus and cap-and-trade bills. With those, the president stuck to the old style of lawmaking: He threw in every special favor imaginable, ground it up and crammed it through a partisan Democratic Congress. Health care is simply too important to the economy, to employment and to America’s families to be larded up and rushed through on an artificial deadline. There’s a better way. And the lessons we learned in Massachusetts could help Washington find it.

No other state has made as much progress in covering their uninsured as Massachusetts. The bill that made it happen wasn’t a rush job. Shortly after becoming governor, I worked in a bipartisan fashion with Democrats to insure all our citizens. It took almost two years to find a solution. When we did, it passed the 200-member legislature with only two dissenting votes. It had the support of the business community, the hospital sector and insurers. For health care reform to succeed in Washington, the president must finally do what he promised during the campaign: Work with Republicans as well as Democrats.

Massachusetts also proved that you don’t need government insurance. Our citizens purchase private, free-market medical insurance. There is no “public option.” With more than 1,300 health insurance companies, a federal government insurance company isn’t necessary. It would inevitably lead to massive taxpayer subsidies, to lobbyist-inspired coverage mandates and to the liberals’ dream: a European-style single-payer system. To find common ground with skeptical Republicans and conservative Democrats, the president will have to jettison left-wing ideology for practicality and dump the public option.

The cost issue

Our experience also demonstrates that getting every citizen insured doesn’t have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar. Second, we helped pay for our new program by ending an old one — something government should do more often. The federal government sends an estimated $42 billion to hospitals that care for the poor: Use those funds instead to help the poor buy private insurance, as we did.

When our bill passed three years ago, the legislature projected that our program would cost $725 million in 2009. At $723 million, next year’s forecast is pretty much on target. When you calculate all the savings, including that from the free hospital care we eliminated, the net cost to the state is approximately $350 million. The watchdog Massachusetts Taxpayers Foundation concluded that our program’s cost is “relatively modest” and “well within initial projections.”

And if subsidies and coverages are reined in, as I’ve suggested, the Massachusetts program could actually break even. One thing is certain: The president must insist on a program that doesn’t add to our spending burden. We simply cannot afford another trillion-dollar mistake.

The Massachusetts reform aimed at getting virtually all our citizens insured. In that, it worked: 98% of our citizens are insured, 440,000 previously uninsured are covered and almost half of those purchased insurance on their own, with no subsidy. But overall, health care inflation has continued its relentless rise. Here is where the federal government can do something we could not: Take steps to stop or slow medical inflation.

At the core of our health cost problem is an incentive problem. Patients don’t care what treatments cost once they pass the deductible. And providers are paid more when they do more; they are paid for quantity, not quality. We will tame runaway costs only when we change incentives. We might do what some countries have done: Require patients to pay a portion of their bill, except for certain conditions. And providers could be paid an annual fixed fee for the primary care of an individual and a separate fixed fee for the treatment of a specific condition. These approaches have far more promise than the usual bromides of electronic medical records, transparency and pay-for-performance, helpful though they will be.