Insurance News

Republicans prove they aren’t putting America’s health first: At summit

Posted on: February 27, 2010

(Health Insurance News) — The most important thing Republicans think is that if there are Americans who can’t afford the health insurance policies that private insurers are willing to offer, then that’s their problem — there’s nothing the government or the rest of us should do about it.

I’m not sure what else was accomplished at Thursday’s Blair House summit, but surely one result is that we learned what Republican “leaders” really think about health care and health insurance.

“We just can’t afford this,” said Eric Cantor, the fresh-faced Houseminority whip from Virginia, while John Boehner, the House Republicanleader, called it “a new entitlement program that will bankrupt ourcountry.” What they were referring to, of course, was the $125 billiona year that Obama and his Democratic allies propose to spend insubsidies so tens of millions of low-income households can afford tobuy health insurance and handle the co-payments. But if paying forthose subsidies means raising taxes on high-income households with lotsof investment profits, or capping a tax break for people withextravagant health insurance, or charging a modest fee on medicaldevice makers that refuse to moderate future price increases, thenRepublicans are agin’ it.

That was their clear message Thursday. It was their message duringall those years when their party controlled Congress and the WhiteHouse and they did nothing and said nothing about the plight of theuninsured. And it is clear that they would continue to do nothing if,by some miracle, Democrats were to drop their plan or embark on a moremodest approach. For Republicans, the uninsured remain invisibleAmericans, out of sight and out of mind.

Judging from Thursday’s discussion, Republicans have much moresympathy for those who can afford to buy health insurance but aredenied because of a preexisting medical condition. They opposeDemocratic efforts to end this industry practice directly throughregulation, preferring instead to refer those customers to specialhigh-risk insurance pools where they would be guaranteed to findcoverage.

In some versions of the high-risk pool, the cost of a policy wouldbe so high that households with average incomes would have to set asidea third or even half of their income to pay for it. It takes aRepublican to view this as a solution — the equivalent of giving astarving man a coupon for $2 off his next dinner at Le Bernardin.

Or perhaps Republicans imagine high-risk pools that are subsidizedsufficiently enough that the insurance policies are actuallyaffordable. Unfortunately, the only way to finance such subsidies isthrough some sort of tax or fee, mostly one imposed on every insurancepolicy sold outside the high-risk pool. It’s a fine idea but one thatturns out to be the actuarial equivalent of what Democrats proposed inrequiring that insurers charge pretty much the same premiums foreveryone, with only modest variations based on age and healthcondition.

Another of the Republican “big ideas” was to make it possible forsmall businesses to collectively negotiate with insurance companies forbetter deals on health plans. But that’s what Democrats have in mindwith insurance exchanges that will do exactly that, not only for smallbusinesses but also for the self-employed and workers at companies thatdon’t offer health coverage. Although they never quite came out andsaid it, what apparently bothers Republicans about these insuranceexchanges is that they would be overseen by governments — the samestate and federal governments that for decades have negotiated a wideselection of competitively priced plans for tens of millions ofsatisfied government workers, including members of Congress.

Then there’s the issue of what minimal level of benefits a basichealth insurance package should offer. Republicans, of course, usedThursday’s forum to denounce the idea that such decisions should bemade by Washington bureaucrats and politicians. But as my WashingtonPost colleague Ezra Klein points out,Republicans apparently would have no problem if those standards were tobe set by bureaucrats and politicians in Nebraska, or North Dakota orwhatever Republican state decided to offer itself up as the regulatoryhaven from which insurers could sell their policies nationwide.

To give them their due, Republicans did manage to raise some seriousissues and make a few constructive suggestions in between theircarefully choreographed talking points.

Sen. Jon Kyl of Arizona, among others, complained that the minimumstandards set in the House and Senate bill weren’t very minimal at all,but in fact exceeded the actuarial value of the average policy now soldin the individual and small-group markets — and are certainly moregenerous than the high-deductible policies that have shown some successin restraining the annual growth in premiums. Why not, he asked, startwith a more modest benefits package?

Rep. Dave Camp of Michigan raised legitimate concerns about the waymalpractice suits and excessive damage awards can cause physicians topractice defensive medicine, needlessly driving up the cost of healthcare.

Sen. Tom Coburn of Oklahoma suggested using undercover agents toweed out the waste and fraud that he claimed were responsible for thefact that one of every three dollars in the Medicare and Medicaidprograms is misspent.

And Sen. John McCain demanded that his former presidential rivalrenounce the special Medicaid funding formulas for Florida andLouisiana that were used to buy the support of those states’ waveringsenators.

What we didn’t hear from Kyl, or Camp, or Coburn or McCain, however,was an offer to vote for a health reform plan if these problems werefixed and their ideas were incorporated. Without even the hint of suchoffers, there was little reason for a willing president and hisunwilling allies to even consider serious compromise. Now the loserswill be the American people, who could have surely benefited from suchproductive dealmaking.

By Steven PearlsteinFriday, February 26, 2010

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