As we await what many in the chattering class anticipate could be the striking of all or part of
the Affordable Care Act by the Supreme Court, it seems like the time is right to explore what the Republicans might have in mind as a replacement.
It would be a fairly dramatic understatement to say that there has been little in the way of proposed alternatives on the part of the opponents of Obamacare.
However, Congressional Republicans appear to now be nervously acknowledging that—should Obamacare go down at the hand of the Court—they will have to make good on their promise to replace the law in order to give the American people the relief the ACA sought to provide.
So, what does the GOP have in mind, if anything?
The ‘preparation gap’ is somewhat astounding. After two years of calling the President’s landmark healthcare reform every name in the book, Representative Fred Upon, chairman of the House Energy and Commerce Committee and the Congressional leader who would be among those most responsible to take the lead in fashioning a new approach to reforming our ailing health care system, suggests that the GOP wheels are just now “beginning to turn.”
Consider that for a moment if you will. Despite the numerous bills that have already been introduced onto the floor of the House of Representatives, each designed to take apart the Affordable Care Act, the sponsors of these bills are, just now, beginning to think about what they will do if the Supreme Court short-circuits Obamacare before it really gets started. Health care reform would be placed squarely in the court of the GOP, Americans will expect them to have something in the oven to meet the challenge and the Republican wheels are, apparently, just now beginning to 'spin'.
Still, there have been a few proposals put forth by our Republican friends—either legislatively or via GOP sound bites and talking points. Many of these suggestions, while certainly representing nothing that would approach a coherent plan, do often bear one common feature – they all adopt much of the very legislation that has been the target of their deepest displeasure.
Put another way, it appears that the GOP strategy for solving our healthcare crisis is, in no small measure, going to involve using Obamacare to replace Obamacare.
According to Chairman Upton, the GOP drafters of healthcare reform would very much want to retain the provision that would allow kids under 26 to stay on a parent’s policy. Why? Because Upton acknowledges that the change has been both effective and popular.
And while Republicans have made the insurance mandates a ‘cause celeb’ in their battle to discredit the President, they appear more than willing to acknowledge that a program that doesn’t provide healthcare coverage to those with pre-existing medical conditions is not going to be well accepted by the American public. It is no secret—on either side of the aisle—that this can only be accomplished via mandated coverage in the private markets or by way of a government operated system to insure folks with pre-existing conditions.
Because the Republicans have long been so adamantly opposed to increasing the government’s involvement in healthcare delivery, they came up with the idea—many years ago—of forcing Americans to take personal responsibility for their health care needs by purchasing insurance.
But that was before Barack Obama adopted this Republican hatched solution.
Now, with nowhere else to turn and with a public that demands that they be able to obtain coverage, no matter what their medical condition, the GOP is left to propose more government involvement.
According to Congresswoman Cathy McMorris Rogers (R-Wash), the GOP is ready and willing to put more federal money into government run, high-risk pools that will offer subsidized coverage to people who are unable to get private health insurance due to their existing medical problems.
Not only is Congresswoman McMorris prepared to expand the government’s role in healthcare, she is offering up the very subsidies that are, supposedly, anathema to free-market Republicans who see no place for taxpayer money in the delivery of health care services.
And she is not alone.
One of the most active anti-Obamacare voices in the Senate, GOP Senator John Barrasso, himself a physician, is also beating the drum for government subsidies.
“The main feature of a Republican plan could be federal assistance for the purchase of catastrophic health insurance with high deductibles, Mr. Barrasso said.
“No one would go bankrupt or lose a home as a result of injury or disease,” Mr. Barrasso said. But patients would face more up-front costs and would therefore have incentives to become more discerning consumers of health care, he said.”
How is this not Obamacare on steroids?
McMorris’ plan, backed up by Senator Barrasso, would not only continue a hefty portion of the government subsidies included in the ACA, but would take a plan that was based on continuing the private health insurance system and turn it into a plan that greatly increases government involvement in delivering health care.
To be sure, there are features of what would appear to form the Republican solution that are not included in the President’s approach. The GOP is mouthing the old standbys of solving our problems by doing something about medical malpractice and allowing cross-state sales of health insurance. However, they also know that that the effort to replace the ACA will be done under a pretty harsh spotlight—one that will expose the completely false promise of these solutions. Let’s begin with medical malpractice. What, exactly, would the proponents of attacking malpractice do? Is Congress going to bar individuals who have been legitimately harmed by a gross medical error—whether committed by a physician or a hospital—from redressing that error? When a family is left to pay millions of dollars in maintaining the existence of a child damaged for life as a result of a serious and grossly negligent medical error, will Congress legislate laws that effectively say ‘tough luck’?
Let me tell you what is really happening here. Those who are voicing the reform of medical malpractice don’t understand that the argument was traditionally based on doing something about the pain and suffering damages juries frequently awarded to victims of gross medical mistakes. These damages go beyond making a plaintiff ‘whole’ with respect to their financial losses resulting from a medical malpractice and seek to punish the negligent actor for the bad behavior. These are also the damages that make the headlines when juries award huge verdicts with endless zeros tacked on.
The thing is, two-thirds of the states have already put severe caps on what can be awarded by juries for pain and suffering damages, leaving those who continue to make the argument well behind the times. As a result, the days of lawyers behaving like ‘ambulance chasers’ are long gone, with plaintiffs often struggling to find representation when they have a legitimate claim. The lawyers simply are not interested because the big awards no longer exist. And yet, the politicians who point the finger at medical malpractice as a chief cause of our problems have not caught up to this reality.
As for reducing defensive medicine (unnecessary testing done to protect a physician or hospital in a medical malpractice suit) as a means of saving big dollars in the healthcare system, I’m all for it. But for the ideologues on the Right, an ideological conflict is presented that they do not know how to overcome.
All government would have to do is provide guidelines for how doctors utilize testing in certain medical situations and ordain that any physician or hospital who follows these guidelines would have the presumption of using proper medical procedure on their side should a legal battle ensure. However, the GOP vehemently opposes such guidelines in the belief that this involves government telling physicians how to practice and further inserts government into the patient-physician relationship.
In the real world, you can’t have it both ways. Thus, a GOP Congress would be forced to make some choices that would fly in the face of their own ideology. Not wanting to make these choices, the result will be that a Republican led House of Representatives would do nothing in this regard.
It might also help you to know that medical malpractice accounts for 2 percent of our healthcare economy. So, if Congress wishes to outlaw medical malpractice as a way of lowering the cost of healthcare, they are going to take a lot of heat as the real numbers become available to the public and we all discover that completely doing away with medical malpractice suits would, at best, have a negligible impact on our problem.
As for sales of health insurance across state lines, I wonder when people are going to figure out that this is the ultimate in false solutions.
If you own an insurance company, it really doesn’t matter where you base your home office —you are going to price your policies based on the costs of care in the area in which you are selling. An insurance company based in Alabama, when selling to someone in California, is not going to base their premiums on the cost of a triple-bypass in Mobile. They are going to price it based on the cost of heart surgery in Los Angeles—just as does an insurance company already operating in the State of California pursuant to a state license.
Further, when you remove the obligation that an insurance company be licensed in the state where they are selling, what you get are fly-by-night operations that sell very cheap policies that end up having very little in the way of benefits included in the policy. Why? Because, if they are selling me the same policy I purchase from California Blue Cross, they are going to have to charge me pretty much the same thing I pay to California Blue Cross. There simply is no magic in having one’s location in another state if they insuring me for care that I will obtain primarily in the state in which I live. Accordingly, to get my business they will price insurance policies low and bury the actual coverage limitations in the small print. Without the benefit of consumer protections provided by my home state—now having no jurisdiction over this out of state seller—I’ve got nowhere to turn when something goes seriously wrong.
Still further, should I have a problem with my Alabama based insurance company, I’m not going to find it particularly comfortable to have to sue them in an Alabama court when I live in California.
Given that the few glimpses we've had of the GOP approach to healthcare reform reveals little in terms of a real and legitimate impact on costs, we can expect that their ideas must do at least as much as Obamacare to gain more universal coverage for Americans. Not so much. While the Republicans are prepared to adopt many of the good ideas contained in the Affordable Care Act, their own contributions would do little to get anywhere near the increased availability for coverage provided in the ACA.
In the plan offered by Republicans as their response to Obamacare in 2009, the Congressional Budget Office determined that the program would result in 3 million additional people gaining healthcare coverage as compared to the 30 million who would so benefit under the Affordable Care Act.
I have often speculated that Congressional Republicans go to bed at night secretly saying a prayer that Obamacare will survive the Supreme Court test because they have nothing in their bag of tricks to serve as a replacement. When we review the ideas that they have provided to date, it becomes easy to see why they would be terrified of having to face up to an American public that has had their appetite whetted for real solutions to our out of control healthcare system. The truth is, they have nothing that will do much of anything to address the real problems. After two years of bellyaching, all they've got are the bromides and sound bites they've been using for years and, without the Affordable Care Act, we are going to need so much more.
So to those who have invested so much in ridding the nation of Obamacare, I say be careful what you wish for as you just might get it. And from what we've seen so far, you most assuredly are not going to like it.
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