An Internet hub for moderates, centrists, and independents, with domestic and international news, analysis, original reporting, and popular features from the left, center, and right

An Attempt At a Real “Reset Button” on Health Care (Guest Voice)

An attempt At a Real “Reset Button” on Health Care”

by Jon Wells

With the convening of Congress, the debate over health care reform has once again reared its ugly head. Despite promises of pushing a “reset button” on the back-and-forth rhetoric, the President’s speech served more as a further partisan rebuke to critics rather than a genuine moment of leadership and bipartisanship. That is his choice and prerogative, of course, but a genuine attempt at common understanding would, I think, be beneficial for the national debate. I certainly can’t speak for everyone on the right, only for myself, but this is how I see it.

First of all, there isn’t anyone in America that is satisfied with the status quo. Health care costs can no doubt be uncertain, as many times the cost of a health care visit isn’t always evident until after you get the bill. And whatever the number (I happen to believe it’s closer to 10 million than the 47 million often cited, which even the President pared down to 30 million to be truthful about covering illegals), there are people without health insurance who genuinely can’t afford it. Medicare will soon be bankrupt, and the growing number of retiring boomers does put a strain on the system. Reform of some sort is needed.

There are a few options not even on the table currently that should be discussed. Malpractice reform is one of these, and even the President conceded that “defensive medicine” may be a contributor to medical costs. Malpractice or tort reform does not mean malpractice abolishment – some sort of redress of gross incompetence must always be available. But in this overly litigious society, the threat of lawsuit hangs over every professional decision in every industry, including the health care industry. Tort reform isn’t a complete solution, but it ought to be a piece of the puzzle. That Obama would put in charge of the tort reform “test cases” an HHS Secretary who served for eight years as head of the Kansas Trial Lawyers Association represents a conflict of interest that belies an indifference in pursuing this path.

Next is the issue of interstate competition. The McCarran-Ferguson Act allows each state to regulate health plans within its borders, which results in different mandates in each state and ends up preventing insurance companies from operating competitively from one state to another. You end up with a situation like the one the President referenced in his speech, where in Alabama Blue Cross and Blue Shield has 75% of the market share(not 90% as the President claimed). It seems like a no-brainer to relax this circumvention of interstate commerce and allow insurance companies to compete in all 50 states, which will result in lower prices (just as in the auto insurance industry) because more entities will be fighting for the dollar of the consumer. A repeal of McCarran-Ferguson might be an answer, but some sort of basic national regulation that waters down the individual state mandates could also be helpful.

This brings us to the public option, which the left assures us is the only viable way to drive down insurance costs. Never mind the fact that a full-blown government plan, in a perfect world, would be the option of last resort, where in this case it’s the first and only choice to be considered. A public option that, according to the advertising, would only exist alongside private insurers to serve as additional competition might serve a useful purpose if it was truly directed at competition, had a limited mandate, and would be allowed to fail if the private insurers proved themselves better.

The problem is that none of those statements, particularly the last, will be allowed to occur. A public option will be allowed to operate at a deficit indefinitely, with infusions of further taxpayer cash if the books look too bad. But the biggest issue is with the idea of competition and the proposition that a public option will only augment the private insurance industry and serves as no existential threat to its function.

The biggest refutation of that come from the public option proponents themselves. Rep. Barney Frank told liberal advocacy group Single Payer Action that a public option “was the best way to reach single payer,” and the President himself told AFL-CIO in 2003 that a single-payer system was what he believed in. Coupled with all the vehement anti-insurance rhetoric, it’s not hard to see that the desire isn’t to exist alongside private insurance, but to squeeze it out completely. It’s especially clear when you consider the high praise from the left for single payer systems like Canada and the UK. The public option isn’t supposed to be an “option,” but an means to an end, and that end is a single payer system.

A single payer system is the Holy Grail of the liberal health care reform movement. If that’s the ultimate ideal, and if single payer is such a superior system, then be loud and vocal and honest about it (and there are intellectually honest liberals who are). The President and Congress, however, knows they can’t be honest about their desire for a single payer system because it would taint the American people’s view of their assertions of a public option that exists innocently alongside private insurance companies. What results is a confusing mishmash of supposed disavowal of a single payer together with an endorsement of its forebear, the public option.

None of these arguments even scratch the surface of the potential cost of a public option in an environment that is seeing decreasing federal revenues and tougher economic conditions. The effects on the national debt and the federal deficit is routinely shrugged off as necessary and self-resolving in the long run. I have my doubts.

All of these views together is what generates anxiety and opposition to the current state of the health care reform legislation. To me, at least, we need to be clear about what the public option is, and what other options exist for lowering health care costs. None of what was stated above is an attack on those who desire health care reform by whatever means – it’s a rational statement of why there are major flaws in the framing of the health care debate.

A broad reset button would have been nice. This is only one man’s meager attempt at explaining the pitfalls of what we currently see. Instead of demonization, it would be nice to see discussion. We won’t see it, though – instead we’ll see blame and a possible nuclear option that will force a particular agenda through at the expense of national unity.

Jonathan Wells is a 28-year-old husband and father who lives in Ohio and has a day job in the microbiology field. He notes that he tends “be conservative in most of my views, but by no means do I bear blind allegiance to a political party.” He stresses that he is open-minded and encourages “any civil disagreement (or uncivil agreement) any of you would care to express.” He likes to make people think – and does so on his blog Wellsy’s World. As he does in the above post — which is cross posted from his blog. Guest Voice posts do not necessarily represent the viewpoint of TMV or its many writers.

  • Leonidas
    It just occurred to me last night, there is one thing that the Democrats could offer in exchange for the public option that might pass Republican approval. If all private insurance costs, the full amount, was tax deductible, whether bought by an employer or and individual, up to a certain amount that would cover anyone with a good comprehensive coverage. Anything more like a gold plated plan would be taxed. Also there would have to be a limit set on other taxation to make sure it was not dramatically increased to "make up for it". Think about it a second. This would ensure viable competition, put more money in the hands of corporations and individuals, and encourage more employment, and greater competitiveness, and greatly expanded and healthcare coverage. Both sides would achieve some major goals. Of course this could be done in the form of a Constitutional amendment so to protect it from being easily overturned by either party when in power. Its bold and daring, but it might just work. It might just be that crazy.

    Ok you can shoot holes in the idea, its probably already full of them, but its the best I could come up with.
  • Appreciate your sincerity, Jon, but you must've noticed that you seem to agree with the merits of a public option, and oppose it solely because you don't trust liberals to keep it optional. You won't accept that concessions are being made on tort reform because you don't trust Kathleen Sebelius. If even an open-minded, nonpartisan conservative like you isn't willing to trust the other side enough to accept that concessions are being made in good faith - despite the fact that all of these liberals who favor a single payer system & oppose tort reform are trying to meet you halfway - then that's what's standing in the way of a reset.

    I know there are rigid, unaccommodating people on the left and right, but the way this is playing out in Congress it's clearly the right that's decided on a strategy of fundamental intransigence. That's the course that those leaders have chosen, and it's that choice that is narrowing the debate so dramatically and pushing a lot of good ideas off the table - and not just conservative ideas, either. You don't have to like Obama's speech, but nothing he says is going to make those standard bearers of the right step up to this issue. What might move them would be some well-aimed criticism from people like you, conservatives who want to see something actually get done on health care reform.

    My opinion: stop talking about a new public option, and start talking about letting people age 50 and up buy into Medicare through the new insurance exchanges (and give them the right to take with them at least some of their employers' contributions to their employer-sponsored plan, if they have one). They get the option right away to buy into an existing progam that will be covering them in a few years anyway. Then if affordability doesn't improve & you need to spur more competition among private plans later on, you can always lower the buy-in age threshhold (and even being able to threaten that will help keep insurers focused on affordability).

    i agree that creating more inter-state competition is critical, but i think the way to do that is to have the exchanges preempt state rules, rather than letting insurers flock to whatever state sets the lowest threshhold for consumer protections. I've got an open mind on the subject, though, as i don't know much about how the interstate rules work w/ auto insurance. It'd be great to read a post about that.

    My biggest concern about the plans on the table now are that they don't make the exchanges strong enough. I see the exchanges as being the way to create a good, functioning marketplace for health insurance; and as long as they only account for a small piece of the market - i.e. as long as large employers can cut their own deals outside of the exchanges - they'll just perpetuate the problem that insurers can carve up the market & make money by SHIFTNG costs rather than CONTROLLING them.

    Thanks for posting Jon's comments.
  • ProfElwood
    McCarran-Fergeson was mentioned once in the mainstream media that I could find, by one politician (Reid). ERISA preemption, which has been taken by the courts to also preempt all lawsuits, is another big wrench in the system.

    I'm glad to see that someone else is taking notice of some of the root causes of our current medical mess, rather than just attacking symptoms.

    Thank you.
  • tidbits
    This is a well reasoned argument against the current proposals. You are correct that the proposals now on the table are more mishmash than coherent policy, that they fail to address health care cost savings and that they portend budgetary uncertainty for the future. I would add that the "mandate" piece amounts to a hidden tax on many middle income wage earners and small businesses, but that's another issue.

    My only critique of your piece would be that I would hope you would follow up with more concrete proposals, including specifically how to reform malpractice litigation ( artificial caps, worker's comp-like system, other?), how to expand coverage to more people, how to control/reduce skyrocketing health care costs and insurance costs, would you support special medical bankruptcy proceedings, how to address duplication of services, over diagnoses and over treatment, pre-existing condition coverage without pricing people out of the market, insurance cancellation tactics, etc. To your credit, you address the interstate competition issue. But, the one argument the other side has that seems to resonate is the failure of conservatives to bring forward alternatives to address the issues. What are your solutions to problems you admit exist?

    Please do a follow up piece with concrete proposals and how those proposals would solve the problems without the flaws and dangers inherent in the various proposals now working their way through Copngress. Thank you.
  • DLS
    "If all private insurance costs, the full amount, was tax deductible"

    Of course. And even vouchers or subsidies could be supplied as well.

    This, in addition to all the reform measures well-known that have nothing to do with the public option.

    After all, the public option has nothing to do with reform -- nobody with a working brain believes the lie about (rigged) "competition" or "keeping the private insurers honest": the public option has always been the incrementalist universal federal health care strategy of choice, intended from the start to replace the private insurers.

    Insisting on real reform and on affordability has never required anything like the public option.

    Let us see if the Democrats will be honest, for a real Change [tm] this year. Odds are, they won't.
  • vey9
    "Insisting on real reform and on affordability has never required anything like the public option."

    How are you going to control costs? We wouldn't be having this discussion if it wasn't for skyrocketing costs. Wait, Wait, don't tell me . . . let's import Chinese doctors. That's how we got cheaper PC's.
  • DLS
    "How are you going to control costs?"

    Some cannot be controlled, those arising from societal aging and from continued medical advances.

    Some can be controlled. For example, an obvious overdue reform addressing portability as well as costs would be a federal uniform standard benefit package, which of course would be true insurance, namely insurance against catastrophic and other expensive (hospitalization) events, and which would be the opposite of what many silly governments (and silly Dems in Washington) want currently, a rich, lavish, comprehensive health care benefits package, often including non-cost-effective preventive care for everyone. (This, at the same time some in Washington want to tax "excessive care" private plans as part of the package of gimmicks purported to pay for what they are promising the naive.)
  • DLS
    Incidentally, Leonidas, it hasn't gone unnoticed that dropping the public option would gain public support for a health reform plan overall.

    http://www.washingtonpost.com/wp-dyn/content/ar...

    http://voices.washingtonpost.com/behind-the-num...


    While the backers of the public option making the news are farther-left Democrats and farther-left interest groups like the unions, the one interesting pro-public-option news item concerns doctors, though it was reported in the New England Journal of Medicine, often a left-activist source, and was from a left-leaning think tank. Still worth noting -- less strident than Kaiser or Families, USA, etc.


    http://www.rwjf.org/healthreform/quality/produc...
  • aficionadaa
    (just to say I've replied to your post but much later)
  • tidbits
    Aficionadaa - Yes, I did see a reply from you late yesterday. It is difficult to communicate immediately with all the time that separates us. By my calculation Paris is nine hours different from the western US where I live. Thank you for your reply.
  • Silhouette
    Congratulations to Governor Bill Ritter of Colorado for winning the online holiday patronage for his State's businesses from the 2009 American Holiday Protest participants!

    Their beef is tops, ski resorts, recreation, unspoiled beauty.. lavish Colorado people. Show them your love $$..

  • Leonidas
    Thats right progressives, take a ski vacation instead of making that donation to charity to help the poor! Show your spirit of compassion by flirting with ski bunnies.Don't worry that you give on average 1.2% as opposed to moderates 3% and Conservatives 4.5% bother you, your helping by sipping booze in the ski lodge.

    If you can't walk the walk, ski the slopes.
  • ProfElwood
    Costs have to be controlled at the source.
    On the private side, overuse can be controlled by making people face the costs of their own medical care, instead of paying only small percentages. Major medical can cover the rest.
    On the public side, spending has to be prioritized better. The Republicans with their "death panels" talk have been the bigger problem on this one, but the Democrats haven't fared much better. Politics tends to get in the way of reason here.
    The system, in general, has been plagued by special interests who have made the laws work against us. The AMA, by setting overly high standards for medical doctors, have limited the supply for their benefit, a tactic that worked way too well with family doctors. They have also fought any use of lesser-trained workers to do the same jobs. Their influence is a bigger problem than most realize. The drug companies are now spending too much money on advertising and making redundant drugs. They've successfully blocked attempts at competition, such as allowing Medicare part D to negotiate prices, or allowing people to buy their medicines from other countries.
    I still believe that political reform is needed before any effective medical reform will be even possible.
  • DLS
    "Thats right progressives, take a ski vacation instead of making that donation to charity to help the poor!"

    "Save" health care first, then take a ski vacation to congratulate each other. Have fun in Vail, Demmies.
blog comments powered by Disqus
© 2005-2009 The Moderate Voice | Site design by Elegant Themes | Site customization, hosting, and security by Enxit Group, LLC