Is the GOP ready for a substantive debate on health reform?

There’s a good debate still to be held in this country on health reform, but only if the Republicans step up to the plate with serious ideas. I’m not that optimistic, but am not giving up hope yet. In Massachusetts the Senate race between Scott Brown and Elizabeth Warren still has the potential for serious engagement, but so far it looks like most of the campaign is about non-substantive issues.

I have more hope for the race to fill Barney Frank’s seat in the 4th Congressional district, where Joe Kennedy III will take the Democratic slot. I’m hoping that the GOP nominee will be Elizabeth Childs, a thoughtful physician (who also happens to be pro-choice and pro-gay rights). I haven’t decided how I’ll vote in the general election, but I’m planning to pull a GOP primary ballot for the first time in order to promote the strongest match-up possible.

As much as I disdain slogans, the GOP’s “repeal and replace” has something going for it in the sense that it promises a strong alternative to ObamaCare. But it’s been a long time since we first heard “replace” and there hasn’t been anything substantive to fill in the details. I would really like to see something better. In the meantime, the latest GOP list is nothing new, and really nothing interesting either. According to Kaiser Health News it includes:

  1. Buying insurance across state lines
  2. Small business purchasing pools
  3. Tort reform
  4. Block-granting Medicaid
  5. Tax deductibility for individuals who buy insurance

Here’s what wrong with the current ideas:

  1. Buying insurance across state lines is an overrated idea. First, are plans from around the country really going to start negotiating with provider groups in other states? I don’t see why they would, and even if they did they aren’t going to get better deals than the local players, such as Blue Cross. Aside from the economic argument, it also seems that this idea goes against the GOP mantra of states’ rights. Buying insurance across state lines implies taking away the rights of states to regulate their own insurance markets, and requiring them to accept decisions made elsewhere on things such as mandated benefits.
  2. It’s fine to let small businesses get together to increase their buying power to approximate what big businesses achieve. But let’s face it, are big businesses pleased with how things are going for them? No.
  3. Tort reform barely even belongs on the list of items for health care reform. Tort reform makes at most a tiny difference to health care premiums. And there’s no compelling evidence that so-called “defensive medicine” would go away even with tort reform.
  4. Block-granting Medicaid is probably the best idea on the list, but by itself it only gives the states an opportunity to innovate. It’s also a double edged sword because not all states will be clever with their funds. It could work if there’s some modest oversight put in place.
  5. I agree it’s unfair to have health insurance be tax deductible for companies but not for individuals. But rather than making it tax deductible for both, I think we should get rid of the tax deduction for everyone. That will limit the tolerance for premium increases and make it more evident that there is a tradeoff between raising benefits and raising wages. Look at this issue objectively and you’ll see that the so-called Cadillac tax in the Affordable Care Act is already getting big companies to think more critically about cost control

It’s really not my responsibility to lay out a serious GOP platform on health reform, but can someone please do so before November? I would suggest focusing more on reform or deregulation on the delivery system side instead of looking just at insurance and other financing. And it wouldn’t hurt to be open to low-cost solutions from abroad including telemedicine with non-US clinicians. And if anyone wants to propose a serious, non-ideological approach to streamlining the FDA I think the trade-off’s are worth discussing.

One thought on “Is the GOP ready for a substantive debate on health reform?

  1. Kevin Knauss

    1. Buying insurance across state lines: Most of the major companies are already in all 50 states like Aetna, Blue Cross, Blue Shield, Humana, UnitedHealth, so there is not much to be gained. In addition, regional players see a whole level of new bureaucracy just to set up in another state. This is a hollow argument receptive to people with little understanding of the market place.

    2. Small business pools is just the recognition that there is arbitrary price discrimination in the market place for no other reason than to increase marginal revenue. Some of the steep discounts large employers groups get are not in proportion to their lower overall cost to administer the plans. We all know the RAF should be based on experience and health of the company, not its size.

    3. The whole tax situation, like many other credits, exemptions and breaks, is the ugly result of lobbying. While I am not a proponent of HSA’s, you can run lots of expenses through them to effectively deduct medical expenses that you could otherwise under the 7.5% AGI rule. Did you know you can deduct the expense of mileage to your AA meetings, the cost of special supplement or food if you doctor recommends to use it, or the cost of a special tutor for you learning disabled child if the doctor refers it? The rules are slanted towards those who can afford a sharp CPA, not us folks working to get by.

    Reply

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