In the sunny wrap-up to the ad, the narrator describes “the Republican plan”: “If you like what you have, you can keep it,” he says. “Access to an affordable basic coverage.” But there is no plan around which Republicans have coalesced. Back in May, some GOP lawmakers offered a bill that would have cut the tax deduction that employers get for offering their employees health insurance plans, and given workers tax credits instead. But there’s been little talk of the bill since then. And Missouri Republican Rep. Roy Blunt was tapped to head a GOP health care task force in February, which was charged “with crafting Republican solutions to increase Americans’ access to quality, affordable health care,” but which so far has produced no plan and seems unlikely to do so.
Of course, Alex Castellanos’ RNC memo makes this abundantly clear. When I originally wrote about the memo, I declined to take on the individual, fake “policy ideas” in the memo because, well, they’re fake. However, I’ve changed my mind. Even though these ideas aren’t part of any GOP plan, you still deserve to know why they’re lousy.Here are the “policy ideas” listed in Castellanos’ memo, with my commentary in bold.
The following is a menu of other bottom-up, common sense fixes (policy ideas) and new language that the patient-centered health care reform movement might support:
* We support requiring/incentivizing doctors and hospitals to post pricing and outcomes. In this day and age, why aren’t the cost of all tests, treatments, procedures and office visits — as well as effectiveness of treatments posted openly on the Internet?
Patients can already request a predetermination, sort of like a written estimate, from their provider or insurance company. The pricing is meaningless to those with insurance, since reimbursement is based on individual provider contracts, and varies greatly based on multiple factors. Even so, you would need a chart of procedures, diagnoses, combinations of procedures (MRI of pelvis and hip cheaper than MRI of pelvis, MRI of hip separately). How would this reduce costs, anyway?
* We believe health insurance companies should compete with each other with simple, one-page contracts/summaries so insurance is simpler, cheaper, and fairer. (Like many banks are doing w/ car or home loans). And how about incentivizing insurance companies to have simple, one page reimbursement forms?
Simple, one page reimbursement forms like this? Done. While it’s not possible to put an entire contract on one page, here’s an example of the typical health insurance benefits summary. They’re pretending to sell you something you already have. Hey, why don’t we have great big doctor-y places? We’ll call them hopsitals or something.
* We believe doctors should be protected from frivolous, expensive lawsuits so they can work together with other doctors and patients in their communities to reduce unnecessary and expensive tests and procedures.
First of all, doctors are protected from frivolous lawsuits. They get dismissed all the time. In fact, according to this study, many more suits are dismissed when there is evidence of injury than are heard when there is not:
When baseless medical malpractice suits were brought, the study further found, the courts efficiently threw them out. Only six of the cases in which the researchers couldn’t detect injury received even token compensation. Of those in which an injury resulted from treatment, but evidence of error was uncertain, 145 out of 515 received compensation. Indeed, a bigger problem was that 236* cases were thrown out of court despite evidence of injury and error to patients by physicians. The other approximately 1,050 cases, in the research team’s opinion, were decided correctly, with damage awards going to the injured and dismissal foiling the frivolous suits.
Second, I don’t even understand their logic here. Doctors are ordering unnecessary procedures to avoid lawsuits?
* We want to change the law so you can take your health insurance with you if you have to change jobs (eliminating expensive and unnecessary insurance turnover).
The Democrats’ plan does this, of course, but the Republicans, at least in their plan’s last incarnation, oppose necessary consumer protections.
* We want to change the law so insurance companies can’t deny you coverage because of pre-existing conditions.
Again, the Democrats’ plan does this, but neither side wants to mandate coverage. That makes this rather unworkable. The insurance model is about shared risk. The one person who waits to get insurance until he has a catastrophic illness or injury cancels out scores of healthy people who carry insurance, and his risk.
* We want to cut out the “Washington health care middle-man,” reducing expensive bureaucracy to produce big health care savings.
Private health insurance companies have exactly the same bureaucracies that the public option will have, with a key difference. While the public plan will operate under the same, or better, medical appropriateness guidelines when determining authorizations for care, the private insurer has the added criteria of profit motive.
There is controversy about the expense of those bureaucracies. While Medicare has administrative expenses of around 3% per claim dollar vs. 10-20% for private insurers, this is skewed by the fact that Medicare patients are older, and have higher claim dollars spent on them. On the other hand, the conservative argument of higher administrative costs per person also ignores the Medicare patients’ high utilization.
Still, it stands to reason that, without the need to turn a profit, the government plan would be cheaper.
* We support (tax incentives?) new paperless, computer-age health care IT systems to reduce the cost of health care management as well as reduce medical mistakes.
Here’s another thing that’s already in the works, as HIPAA is being rolled out for theses very purposes. Note the question mark, denoting that this isn’t actually a policy position, but a spitball.
* Every American should have equal opportunity to get the best value and buy the cheapest insurance no matter where he lives or whom he works for. We want to change the law so any American can buy the lowest cost insurance available nationwide, not just in their states — whether from insurance companies, businesses, church groups, college alumni associations, or groups like the AARP, who often provide it less expensively.
Like John McCain, Castellanos fails to address the insurance regulations of each state, although McCain was clearly in favor of less regulation. As I said before, there are important consumer protections in those regulations.
* The Wall-Mart way to bring costs down is better than the Washington way. So we want to use consumer-buying power, also called “group buying power,” not Washington price-controls, to bring health care costs down.
* We support effective prevention, wellness, and disease management programs because they will improve our health and save money.
This isn’t very clear or specific when it comes to the kind of “support” they offer. It sounds like they think those things are a good idea. Great, we’ll see that insurance companies keep using those. Do you also support the use of “beds” in hospitals? Good, more progress.
* We support bold new tax deductions for companies that develop new treatments and cures because that is smarter than paying for chronic long-term illnesses we can’t cure today.
* We believe in bottom-up health care savings: every American should get a tax deduction for their health insurance premiums.
They don’t say how much, but McCain’s plan called for a $5000.00 deduction. He paid for it by taxing everyone’s employer-paid health benefits. Not just “wealthy” Americans, but all Americans. That $5,000.00 won’t get you very far in the individual insurance market.
* We believe the working poor should get a refundable, advanceable tax credit to help them get health insurance.
* We want to incentivize and expand practical, down-to-earth reforms that are already working and reducing health care costs all across America. Safeway’s plan, which gives employees a stake in holding down health care costs, is a model. Instead of cutting care or shifting costs to employees, Safeway has held health care costs flat the last 4 years, while it’s up 40% for the rest of corporate America.
Again, this is not a policy proposal, but rather, an observation of an already-occurring trend. The Democratic plan also emphasizes wellness programs, to the derision of conservatives.
Steven Burd, Safeway’s CEO, recently wrote an op-ed extolling the virtues of their plan, emphasizing their wellness program and its relationship to premiums. Certainly, everyone agrees that wellness programs are a good idea, but some of Safeway’s claims are dubious. They don’t specify whether their flat health care costs include employee cost-sharing, or just premium and claim dollars. In the op-ed, Burd fails to mention that Safeway’s plan is a high-deductible plan, which creates a deterrant to using medical services. While the wellness programs may have helped, the $2000.00 deductible probably kept people out of the doctor’s office, too.
* We support special “too much paperwork” tax credits for small businesses, so they don’t have to bear the intolerable costs of filling out insurance forms or meeting government mandates and regulations.
This is vague nonsense that’s designed to have superficial appeal. Who doesn’t want less paperwork, and a tax credit? Reminds me of those old TV commercials that told you how the products were filled with “goodness.”
* We want to give small businesses the same cost-saving breaks big businesses get by helping them form small business health plans and small business health co-ops.
This isn’t a terrible idea, but also not one that’s likely to result in the kind of savings Americans are looking for. Even large group insurance plans are costing Americans too much. Plus, again, this is a spitball, with no specfics, just the evocation of the GOP’s fetish du jour, the small business.
* And no lifetime health care benefits and insurance for Congressmen who leave their jobs — unless and until everybody else in America has the same.
This is the only part of the memo where the uninsured are mentioned, albeit indirectly. So, your “plan” does nothing to achieve universal coverage, but you ofer to give up lifetime insurance if we’ll just shhut the hell up about it. And it would never pass. You might as well say you support a law making congress mow everyone’s lawn.