Thursday, November 5, 2009

Health Care Thursday

This comes up from time to time, but it's good to see former House Majority Leader Dick Armey (R-Texas), a new ringleader for right-wing activists, state it plainly.
"The largest empirical problem we have in health care today is too many people are too overinsured," he said.
There it is, the right's philosophy on American health care in 17 words. Most of us think the problem with the existing system is that we pay too much, get too little, and leave too many behind. Dick Armey sees the existing system that thinks we'd all be better off with less coverage.
Lest anyone think this is unique to Armey, the opposite is true. A few years ago, during Bush's pitch in support of health saving accounts, the LA Times' Peter Gosselin explained, "Most conservatives -- including those in the [Bush] administration -- believe that the root cause of most problems with the nation's healthcare system is that most Americans are over-insured."
Just two months ago, Reps. John Shadegg (R-Ariz.) and Pete Hoekstra (R-Mich.) had an op-ed in the Wall Street Journal making the same case. "When was the last time you asked your doctor how much it would cost for a necessary test or procedure?" they asked, making the case that consumers need more "control ... over their care."
For those with insurance, we visit a physician, and follow his/her recommendations, knowing that insurers and our employers will shoulder most of the costs. If we didn't have that pesky insurance -- if we had more "control" -- we could, you know, haggle and stuff. Think of the savings!
It's all premised on the notion that health insurance encourages medical treatments. If we have coverage, we might tests and procedures that we wouldn't get if weren't so darned insured. Less coverage means fewer costs.
Josh Marshall recently explained:
The problem is that you go to the doctor and agree to take the tests the doctor recommends. Shadegg and Hoekstra want a system where if your doctor suggests a biopsy for a suspicious lump you think about the pros and cons. Is it worth the money? Do you have the money? How suspicious is the lump anyway? Maybe you get the first one. But not necessarily the follow up scan six months later.
This is the essence of the Republican plan: the fact that you're insured and aren't directly feeling the cost of individual tests and procedures is the problem and getting rid of the insurance concept is the solution.... [T]he problem according to most Republicans in Congress isn't that there's not enough insurance or that it's not good enough. It's that there's too much. The problem is that you have insurance. And good policy will take it away from you.
Dick Armey is only saying explicitly what conservative lawmakers have been arguing for quite a while.
Ezra Klein: Congressional Budget Office Thrashes Republican Health-Care Plan 
Republicans are learning an unpleasant lesson this morning: The only thing worse than having no health-care reform plan is releasing a bad one, getting thrashed by CBO and making the House Democrats look good in comparison.
Late last night, the Congressional Budget Office released its initial analysis of the health-care reform plan that Republican Minority Leader John Boehner offered as a substitute to the Democratic legislation. CBO begins with the baseline estimate that 17 percent of legal, non-elderly residents won't have health-care insurance in 2010. In 2019, after 10 years of the Republican plan, CBO estimates that ...17 percent of legal, non-elderly residents won't have health-care insurance. The Republican alternative will have helped 3 million people secure coverage, which is barely keeping up with population growth. Compare that to the Democratic bill, which covers 36 million more people and cuts the uninsured population to 4 percent.
But maybe, you say, the Republican bill does a really good job cutting costs. According to CBO, the GOP's alternative will shave $68 billion off the deficit in the next 10 years. The Democrats, CBO says, will slice $104 billion off the deficit.
The Democratic bill, in other words, covers 12 times as many people and saves $36 billion more than the Republican plan. And amazingly, the Democratic bill has already been through three committees and a merger process. It's already been shown to interest groups and advocacy organizations and industry stakeholders. It's already made its compromises with reality. It's already been through the legislative sausage grinder. And yet it saves more money and covers more people than the blank-slate alternative proposed by John Boehner and the House Republicans. The Democrats, constrained by reality, produced a far better plan than Boehner, who was constrained solely by his political imagination and legislative skill.
This is a major embarrassment for the Republicans. It's one thing to keep your cards close to your chest. Republicans are in the minority, after all, and their plan stands no chance of passage. It's another to lay them out on the table and show everyone that you have no hand, and aren't even totally sure how to play the game. The Democratic plan isn't perfect, but in comparison, it's looking astonishingly good.
  •  Steve Benen adds:
    So, let me get this straight. The House Republican caucus has been working behind closed doors since June on a health care plan. Five months later, they unveil their plan, and it effectively leaves the broken status quo intact? That's the big GOP health proposal? Largely ignoring the uninsured, neglecting those with pre-existing conditions, and offering deficit reductions that are smaller than the Democrats' plan?
    House Education and Labor Committee Chairman George Miller (D-Calif.) said of the GOP plan in a statement, "It will leave 52 million Americans literally out in the cold, does nothing to help low-income and middle-class families afford quality health care, and protects insurance companies' power to deny claims and stand between patients and their doctors. Their bill fundamentally fails to repair our broken health care system."
    Now, keep in mind, Republican leaders concede that their approach effectively ignores those who currently lack coverage. As far as the GOP is concerned, helping those with no insurance costs too much, so their plan barely tries to address this aspect of the health care crisis. Instead, they argue, the key to reform is cutting costs, so that's where Republicans focused their energies.
    But this is wrong, too. Jonathan Cohn explained this week, "This is a politically clever construction, since it creates a narrative that is both intellectually simple (Democrats focus on coverage, Republicans focus on costs) and consistent with preconceptions about the parties (Democrats want to help the poor, Republicans want to help everybody else). But it's not actually true. President Obama and his allies have made controlling costs a top priority of health care reform ... and the bills moving through Congress show it."
    I expected a bad Republican plan, but this is even worse than I imagined.
    In terms of getting the word out, however, the public will probably not hear much about the GOP proposal. Democrats are largely focused on passing their own bill, and the media realizes that the Republican plan has no chance at becoming law.
    But that's a shame -- the public should realize that there are two competing approaches to the same problem here, and one of the two is ridiculous. The White House is trying to shine a light on the GOP plan, and here's hoping that some of the major outlets notice.

  •  from the comments:
    You and Josh aren't quite right on this, I'm afraid. At least if "This American Life" was accurate in its recent show on health care ("Other People's Money"), the problem isn't about getting two recommended biopsies or one. It's about getting tests that are completely unnecessary according to actual doctors. We ALL do it, it drives costs insanely high, and doctors (apparently) are unwilling to say "don't get this test because it's 99% likely to be a waste of money," because there's a teensy tiny chance they could miss something and get sued, and the patient demands to have all their bases covered. And they do this because, once they're paid in, they never see the cost difference between one test and another.
    The show is here, Oct. 16th. It's possibly the most entertaining hour I've spent hearing health care discussed--and contains the single best explanation I've ever heard of how we wound up with crazy employer-based health care in the first place. 392: Someone Else's Money
    Posted by: Wordboy Dave on November 5, 2009 at 9:28 AM

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