On healthcare, Republicans earn deep skepticism
Allow me to bury the lead by beginning with a couple of the usual caveats:
I think it’s perfectly reasonable for people to debate the design, implementation, cost and philosophical principles underlying the Democrats’ Healthcare Reform Act.
A lot of legitimate questions remain about how the program will be paid for long-term, how many people it will actually help, and whether better, less complicated and less intrusive alternatives might be found.
And now for the punch-line: As they seek to score political points on “Obamacare,” Republicans have largely blown their own credibility as the party with the right ideas to answer those questions.
Indeed, GOP leaders have earned for themselves a deep reservoir of skepticism.
The first blunder, of course, is that top Republicans have adamantly refused to offer alternatives, or talk about how they would approach this differently.
Nor have they adequately explained the fact that during the years when Republicans controlled Washington, they ballooned the public costs of healthcare (pushing through a huge, budget-busting prescription drug entitlement for seniors) without addressing the tens of millions of Americans with no insurance coverage.
So when Republicans say their message in 2012 will be “repeal and replace,” journalists like myself and voters like you should be asking for specifics: Replace with what? How will you get it right this time?
The other reason the GOP has drifted into “pants on fire” territory on this issue is that so many of their most adamant claims about the Democratic plan have turned out to be flimsy, exaggerated or downright false.
Just this morning on our airwaves, New York state Republican leader Dean Skelos argued that a new Congressional Budget Office accounting of Obamacare suggests that it will cost twice as much as originally predicted.
This is a widely parroted theme among conservatives and it is, simply and factually, false. Here’s what the non-partisan website FactCheck.org found when they looked at this issue:
Several readers asked us about Republican comments and news reports saying that a new Congressional Budget Office report had found that the federal health care law would cost double the original estimate. But that’s not what CBO’s report said. Instead, the report shows that the gross yearly costs of the new health care law are likely to be 8.6 percent higher than originally estimated.
Politifact — another non-partisan fact-checking team — reached the same conclusion, calling conservative claims bluntly “false.”
Politifact also investigated conservative claims, echoed by presidential candidate Mitt Romney, that the Healthcare Reform Act would somehow ration or deny certain Medicare treatments received by elderly Americans.
Their probe concluded that the assertions were “pants on fire” lies, saying that the a new political ad about the issue “isn’t just wrong. It’s also ridiculous.”
So what’s up with that? If Obamacare really is so toxic, why does the GOP have to keep trotting out full-blown whoppers to attack it? If the truth about the program is ugly, hit us with the truth.
And then there’s the complicated issue of whether or not the GOP’s top candidate, Mitt Romney, actually some of the most controversial policy provisions of Obamacare, while serving as the governor of Massachusetts and while campaigning in 2008.
The Washington Post’s Factchecker site concluded that Romney embraced the idea of personal mandates, insisting as recently as 2008 that “mandates work.”
But Romney never embraced a national mandate requiring that all Americans purchase health insurance.
That’s an important distinction, but it still leaves a lot of of unanswered questions. If mandates work but we don’t want them in national policy, what are the alternatives?
How does the GOP leadership plan to confront the complex, thorny problems posed by uninsured Americans, both those who can’t afford coverage and those who carelessly choose not to buy protection, thus ballooning costs for the rest of us?
As Republicans campaign this summer, these are the questions that they should be answering. And to win the high ground on this issue, they should make sure that their answers are based in fact.
Tags: analysis, election12, health, politics
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Also, in my scenario, the doctors would not be faced with high liability insurance costs. They would also pay less in taxes (in a conservative world).
This would allow them to directly charge patients for the actual cost of the service they provide, without having to mark it up 10x for the ridiculous government and liability issues.
Doctors could, once again, enjoy high incomes on small practices while health care costs remain reasonable and affordable, and everyone pays their own way.
This is the market-driven universe. Unfortunately, we don’t live there, but we could.
JDM, your market-driven solution is pure fantasy. The reality is there are a few very large private health insurance companies that spend millions of dollars lobbying politicians for preferential tax policies and regulations that benefit them directly at the expense of the consumer and competition. The CEOs of these companies are obscenely paid for being nothing more than paper-pushers. They add nothing to healthcare other than increasing the cost 20%. There is no private market competition in health insurance and it is foolish to think there ever could be.
Walker,
I think the government strategy should be to focus almost totally on bringing the cost of health care down. So I am not saying it can’t be done and you are right a starting point would be holding the line for one year on medical inflation, which is going up every year at really crazy rates, far above the core rate of inflation. If medical care was not so insanely expensive in the US EVERYTHING would change. We could easily afford private insurance and the government could easily afford to provide public health care for those who could not afford private.
We should be increasing the supply of health care, this bill will reduce the supply of health care in the US.
Again I’m at a loss. How is our current health care system not market driven (except for the obvious MediCare and MediCaid)? You buy health insurance (market driven) or not, you get sick, you get health care from a doctor or hospital (mostly market driven with a few exceptions), your health insurance company pays (with a lot of tooth pulling in many cases) or you pay out of pocket or don’t pay if you can’t afford it. If you can’t afford to pay, market principals cause the insurance companies, doctors, and hospitals to charge more. Unless I’m missing something, that sums up our current market driven health care system.
So the CONS keep coming back with their TORT Reform solution when in reality tort claims and payments represent a small pecent of our health care costs. BTW, I have a sneaky feeling that if JDM went in to surgery for an appendectomy and he woke up hours later with a sex change, there would probably be NO LIMIT to the amount of tort $$$ that JDM would be demanding from the Doctor’s insurance company.
Then they suggest that we should leave health care in the hands of the Free Market. The Free Market may be a fine instrument for regulating the trade of apples, cars, computers, trinkets and puppies.
But we are talking about human beings here still, right? Asking people (regardless of ability) to pay for their own healthcare in a free market, dog-eat-dog, hunting for bargains on a basement budget is cruel and unusual in my lexicon of American beliefs.
In my America those who have feel an obligation to care of those who have not. I am not a wealthy man but I do what I can for my fellow man locally, expecting nothing in return other than hoping in my liberal, bleeding-heart, that others follow the golden rule in their treatment of total strangers.
As I understand it with the ACA if you choose not to get insurance and are willing to ignore the penalty and throw away the letters you receive from the government asking you to pay there is NO enforcement mechanism?
Even if you support the law how could you vote for such a “toothless” mandate? Like I said I hope it works out but given things like this there isn’t much hope for it.
I think I agree with Mervel. The recent program on PBS something like “The Good News about US Healthcare” with TR Reed had many good example of ways to lower costs that many clinics and hospitals in the US are doing right now. These are the kinds of things that everyone can agree on and makes very good sense.
Instead we find ourselves as two opposing mobs outside the Supreme Court.
PNElba: Again I’m at a loss. How is our current health care system not market driven…
It is, in the worst sense of market-driven. There is very little correlation between receiving a service on a given day, and paying for it, directly, thereby giving market forces a chance to allow competition to increase value.
You buy health insurance (not market driven): Few pay directly. It’s usually through an employer where most of the premium is paid by the employer. Sometimes, all of the premium is paid, by the employer or government agency.
you get sick, you get health care from a doctor or hospital (not market driven): your doctor knows that you are not his “customer”. You insurance is who is going to pay, so, if the insurance demands extra tests, he will do them for their sake, not yours.
your health insurance company pays (not market driven): you are not aware of the total cost of the services or of the payment until long after the fact.
you pay out of pocket (at the inflated rate due to lack of market forces)
or don’t pay if you can’t afford it (not market driven): the tax payers pay for your services.
I see no reason other than because “it is the right thing to do” that will make people purchase health insurance after this law is fully implemented. As many have said here we already have that “incentive” and it isn’t working. After implementation people will definitely take advantage things like buying insurance when they are on the way to the hospital. There is plenty of incentive there when you just had something like a stoke or a heart attack. How can this dynamic not drive health care costs through the roof?
Good intention, poor implementation.
Even if you tell folks that they will be left to die if they don’t have insurance or can’t pay out of pocket they still will not comply. They will just go on thinking that they will not get sick.
Apparently the CBO estimated in 2010 that more than 20 million Americans would remain uninsured even with the mandates and subsidies in the bill. If that is true will this law really accomplish anything?
It sounds like Romney is siding with the CBO in saying that the mandates won’t work. Many pants on fire here?
http://www.cbo.gov/publication/21351
And this isn’t too comforting:
“Reform Is No Cure for Insurer Discrimination, Health Experts Say”
http://www.washingtonpost.com/wp-dyn/content/article/2009/10/03/AR2009100302483.html
Brian Mann: “How does the GOP leadership plan to confront the complex, thorny problems posed by uninsured Americans, both those who can’t afford coverage and those who carelessly choose not to buy protection, thus ballooning costs for the rest of us?
As Republicans campaign this summer, these are the questions that they should be answering. And to win the high ground on this issue, they should make sure that their answers are based in fact.”
Too bad that Cong. Newt, Gov. Willard and Sen. Rick, even Pres. Barak, won’t be taking a look at Brian’s letter and the follow-on comments at our NCPR blog.
Much to contemplate and learn here from all sides of the health care issue.
Frank, If I were a candidate I would have to focus on things that have already worked in lowering costs and expand on those, then look at other things that could incrementally lower costs as well.
http://www.pbs.org/programs/us-health-care-good-news/
“Their work began in the 1970s, when doctors and economists began reviewing Medicare billing records by the millions. It sounds pretty boring, but in fact, they found something amazing: Massive variation from one town to the next in the treatment of the same ailment. This leads to massive variation in the cost of treating the same ailment. As a result, some U.S. counties spend $17,000 per year on the average Medicare patient, while others spend less than $7,000 per year with results that are just as good.”
Thanks, Paul for the site.
Massive variation in treatment costs is another major problem.
I think the government should mandate people eat broccoli. Certainly members of the Supreme Court need it to correct their mental imbalance.
Paul: “the CBO estimated in 2010 that more than 20 million Americans would remain uninsured even with the mandates and subsidies in the bill. If that is true will this law really accomplish anything?”
Yes, Paul, since presently there are 44 million uninsured. So the law will cause 23 million more people to have insurance. And the 21 million will be exempted for all sorts of good reasons; it’s only a bit over a page long if you want to read through it here.
You conservatives are starting to sound a bit desperate to find reasons that it just won’t, can’t possibly, no-how-no-way work. Why is that?
Paul writes: “Frank, If I were a candidate I would have to focus on things that have already worked in lowering costs and expand on those, then look at other things that could incrementally lower costs as well.”
Well, Paul, trouble is, that’s already in the ACA:
“But much of the law’s 905 pages are dedicated to an effort that’s arguably more ambitious [than covering the uninsured]: an overhaul of America’s business model for medicine. It includes 45 changes to how doctors deliver health care — and how patients pay for it. These reforms, if successful, will move the country’s health system away from one that pays for volume and toward one that pays for value. The White House wants to see providers behave more like Baptist Health Systems, rewarding health care that is both less costly and more effective.”
As for your discomfort at the Washington Post article, “Reform Is No Cure for Insurer Discrimination, Health Experts Say,” the article addresses the issue directly:
“Cognizant of the threat, lawmakers are trying to neutralize it. For example, the bill advanced by Senate Finance Committee Chairman Max Baucus (D-Mont.) calls for creation of complex mechanisms to essentially raise or lower compensation to insurers, depending on whether they attract disproportionately sick or healthy populations.
The bill assumes the problem would be greatest during the first few years; after that, part of the machinery to compensate for variations would go away.
A straightforward way to reduce gamesmanship is to standardize benefit packages, Precht wrote in a July report. One issue lawmakers must resolve is how much latitude to leave insurers over what they cover and how. “
A relevant comment borrowed from the New York Times by someone self-identified as Javier in Austin:
“We ALREADY HAVE mandatory health insurance that is constitutional, and that is called Medicare. Anyone who ever works for a living is required to pay premiums into medicare. Everybody gets it when they retire. Its mandatory, and just about everybody LOVES it. This is not about the constitution or rights, its purely republican politics. The idea of mandates is a REPUBLICAN idea to begin with, starting as early as Richard Nixon in 1974. Democrats have ALWAYS preferred a single-payer, medicare-for-all type of thing, they opposed mandates. Finally, Democrats cave, adopt the mandate plan, and Republicans suddenly think its a terrible idea. So if the mandates are thrown out, the only path left for health care reform will be to go for a medicare-for-all system run entirely by the government. Insane that republicans would oppose a system that involves private companies and competition to provide insurance, leaving the only possible alternative as a fully government program like medicare. Its pure politics and makes no sense at all.”
[Actually he’s wrong about receiving Medicare being mandatory– to get it, you have to sign up for it, and if you do, you have to pay $100 a month for it. But he’s right that you are required to contribute to it if you work for a living.]
“You buy health insurance (not market driven): “
Ok, this makes me even more confused. If health insurance isn’t market driven, why are conservatives so hot on allowing purchase of health insurance across state lines?
This really has nothing to do with markets, big government or the Constitution.
Obama passed Obamacare.
GOP hates Obama.
GOP will do anything it can to stop Obamacare.
Not hard to figure out.
Obamacare is soon-to-be-history.
Nah nah nah nah
Nah nah nah nah
Hey a a
Goodbye
Then the GOP can put a real solution on the table. Not this fly-by-night gooblty-gook of a bill.
Justice Scalia, “Do you really expect us to read through 2700 pages and decide on each item, line-by-line. Is that not ridiculous?”
Yes. Ridiculous.
Yes, JDM.
It would be very ridiculous for any of us to expect a proverbial Obama scoffer such as yourself to read through 2700 pages of this bill. That probably seems like a lot of reading to a CONservative fellow who likes his reading in short and pithy sound-bites?
But, it is ridiculous for a man, Justice Scalia, a big-time lawyer whose salary and health benefits are being paid by for the American tax-payer (and maybe some of those Superpac Guys?) to not take time from his duck hunting with Dick Cheney to read what the law has to say!!! Or at least get crib-notes from his wellpaid staffers, all lawyers with “real” degrees from Regent’s University I suspect.
How ridiculous my *ss.
Nahnahnahnah to the American people brought to you by Scalia? Now that would be sick!
You would think that a Supreme Court Justice who has spent a lifetime in the law, who gets paid to read, would do his job and not be a whiner. If he doesn’t want to do the job he’s paid for he should retire.
Speaker Nancy Pelosi on her watch:
“You have to pass it to find out what it is in it”
I guess she didn’t know, either. No wonder it’s a joke.
Different issue JDM. Just because Congress has its own problems doesn’t mean the Court shouldn’t do theirs.
Scalia should at least be familiar enough with the healthcare law to know that the so-called “cornhusker kickback” was removed.
khl:
I was merely pointing out the selective indignation which is stereotypic of liberals.
Who says it is selective? Passing bills that nobody reads is a tactic both parties have engaged in. Passing bills has been a dirty business for a long time. I am a strong supporter of the Occupy movement which is working very hard to clean up that sort of thing. What are you doing about it?
I think the legal argument is that this law is different than medicare in that there is a duty to act in the private sphere, which may be an infringement on our liberty.
A more honest way to go about health care would have been to just add another medicare tax and fund it that way or simply expand medicare to be universal in nature.
One way to do this that would have government paying and yet has market elements; is to have a universal tax paid to the government, much like medicare (although I would want non-wage incomes taxed also), then let us choose our own providers. We need to look at ways to encourage competition among medical providers, part of that will be to look at regulations which are controlled by the medical field today. You can’t be a good consumer unless we know information, what is a good doctor, what is a good hospital, what is a good drug company, how do we choose when we don’t have information?
Also we have to get away from pay for service, we should be paying for health care.
You’re right about the lack of sound information, Mervel, and a lack of information makes the idea of a market laughable– markets basically run on sound and complete information. One problem, though, is that medical care has become so complicated that being able to adequately evaluate medical information is difficult.
Lots of things are getting too complicated– I feel like I’m working from a barely educated guess buying a new laptop these days, even though I’ve been a heavy PC user from the early 80s. Even though there are lots of ratings and consumer reviews etc. there are so many models to choose from it is truly bewildering. And the same circumstance applies to many other things.
But health care is so much more important, and there is so much less unbiased information, and so many people out there are trying to make a buck off of it. And it’s hard to imagine a way to get good information to people that couldn’t be subverted to fatten someone’s bottom line. Can’t say I’m feeling real optimistic.
khl: “I am a strong supporter of the Occupy movement which is working very hard to clean up that sort of thing. What are you doing about it?”
Being a strong supporter of the Tea Party movement, which is trying to clean up that sort of thing.
If this legislation is constitutional I hope it works out.
And if it isn’t – it goes based on that and only that.
As a side note, I believe the greatest problem we are facing on all fronts is this: we lack leadership in our government. The powers that be should lead by example. That speaks volumes in any venue. Instead, it’s do what we say not what we do.
“You conservatives are starting to sound a bit desperate to find reasons that it just won’t, can’t possibly, no-how-no-way work. Why is that?”
Walker, decaf again man decaf.
If you read my other comments you will see that I said that if the law is constitutional than I hope that it works out. How is it that you translate my comments (maybe you are referring to someone else?) to be some desperate bid to find reasons that it will not work? These are just observations many of which I hope I am wrong about.
Clearly you are a big supporter of this legislation. I support whatever will work, if this is it then fine. It is already a law so we will get the chance to see if it works.
If it is unconstitutional that it is unconstitutional., and liberal or conservative or whatever, you should be glad that it is being changed or tossed. The case will not be decided by Scalia it will probably be decided by Kennedy a justice that is seen as very fair and balanced by both liberals and conservatives alike.
JDM, as I have said in the past, I agree with the Tea Party movement in that they see there is something very wrong happening. I wish they were more open to other ideas on how to fix what has gone wrong.
Paul, you don’t really sound like you hope it will work out…
“Many doctors will stop taking other types of insurance just like they are not taking medicare anymore once more of this law goes into effect. They can’t handle anymore patients anyway.”
Even if you support the law how could you vote for such a “toothless” mandate?
“How can this dynamic not drive health care costs through the roof? Good intention, poor implementation.”
“…more than 20 million Americans would remain uninsured even with the mandates and subsidies in the bill. If that is true will this law really accomplish anything?
“Reform Is No Cure for Insurer Discrimination, Health Experts Say”
And surely you’re not serious, thinking that the present court simply and straightforwardly determines the constitutionality of laws, without regard to politics. That’s not the court I’ve seen at work lately.
And truthfully, no, I’m not a great supporter of this approach to health care reform, but I am a great supporter of some form of health care reform, and if this is the best we can get out of this Congress, then I’m for it. I hope enough can be salvaged to serve as a basis for further improvements. If the SC tosses the whole thing out, god only knows when we’ll get another shot at it.
Walker: If the SC tosses the whole thing out, what does that say about the whole thing?
Well, what it would say to me would depend a lot upon the reasoning. But the Court has been significantly politicized since the 1980s.
“…in the 5-4 decisions, the Court divided along the traditional ideological lines (with Ginsburg, Breyer, Sotomayor, and Kagan on one side, and Roberts, Scalia, Thomas, and Alito on the other, with Kennedy providing the “swing vote”) in 14 of those 16 cases (87% of the time, the highest rate in the past 10 years). The conservative bloc, joined by Kennedy, formed the majority in 63% of the 5-4 decisions, the highest cohesion rate of that bloc in the Roberts court.” (Wikipedia)
If it’s a 5-4 decision along party lines to overturn the law, it simply means conservatives hate the law…..nothing else.
“If the SC tosses the whole thing out, what does that say about the whole thing?”
Simple, it means we should have a single-payer system like Medicare for everyone.
“If it’s a 5-4 decision along party lines to overturn the law, it simply means conservatives hate the law…..nothing else.”
Perhaps, but they will have a very very long decision written that will describe their reasoning whichever way it goes. The courts reasoning will be sound and it will be ignored by the press (not an interesting story to look at the facts). Nothing new there.
“And truthfully, no, I’m not a great supporter of this approach to health care reform, but I am a great supporter of some form of health care reform, and if this is the best we can get out of this Congress, then I’m for it.”
Sounds like we agree here.
Walker, thanks for regurgitating some of my comments as if this thread isn’t long enough already!
Like I said these are just weaknesses that may or may not be in the law. Our discussion here has no bearing one way or the other so my comments or yours have no impact on the outcome. Yes, this may be the best they could do?
The president and supporters of the law must have seen this train wreck coming. If they did not they are not as smart as I thought that they are. Maybe nudging folks toward the single payer system that myown comments on is what the goal was all along. Who knows? What an expensive and potentially time wasting exercise this may end up being.
This thread is getting too long for Scalito to read.
I hope Brian Mann gets better soon and posts something else we can all disagree on.
Don’t quit now– only six more to two hundred posts! Have we ever hit 200 before? Here’s something to keep it going… does everyone know about former insurance executive Wendell Potter?
Good link Walker but there is a good way to find out just how much of a scam health insurance is — ask for an insurance broker to come and talk to your small company about buying insurance. They will tell you how complicated it is, how companies work to create multiple plans with varied options, how there are literally thousands of comparisons that should be made and that an ordinary person just can’t make a good decision without hiring someone else. Pretty soon you’ll figure out that all the “choice” is there just to confuse you. A true free enterprise system requires that the individual who buys a good or service be able to understand exactly what they are getting and compare it to other similar goods or services.
Once you pick a provider they raise the rate the next year. The change in rate is not determined by what services you have or haven’t used but by a statistical analysis of the “pool” of people who are in your plan. If they want more people in the pool the increase will only be 5-10% if they want a smaller pool the increase can be 15 or 20% or MORE!
The more I talk to my insurance broker and find out how the system works the more I am convinced that it should be illegal. I encourage everyone to call a broker and find out for yourself.