"Don't Get Sick": The Truth About GOP Health Plans?

Republicans reacted wtih outrage last week after Rep. Alan Grayson (D-FL) offered a blistering attack on the nearly-invisible Republican healthcare proposals: "The Republican health care plan is this: Don't get sick, and if you do get sick, die quickly."

Unfortunately, the White House isn't doing all it can to push the public option. Indeed, The Hill reported Friday, the White House staff and the President didn't make any phone calls to Senate Finance Committee members before last week's vote on health reform to press for that provision. The upshot is that the odds have increased that only reform-lite may pass, although there's still a strong grass-roots effort, including by union members, to push for the public option.

But SEIU's Andy Stern and other progressive leaders have noted that Grayson, despite his hyperbolic rhetoric about "die quickly" and a "Holocaust," was correct about the impact of inaction on health reform: 44,000 people die each year because they lack health insurance. Indeed, Stern said at an Atlantic Magazine-sponsored conference last week:

"[Republicans] have no healthcare plan and they are letting people continue to suffer," he said. "That is an issue and they should be held accountable."

Yet during the President's healthcare speech before Congress last month, many Republicans were shown holding up copies of their 37 House bills to counter the well-deserved notion that they're the "Party of No," dedicated to obstructionism.

But even some Republican proponents of their own legislation quietly concede that the Republican leadership hasn't seriously pushed its own alternative healthcare plan. One Republican staffer, when asked about the Republican over-emphasis on attacking Democratic plans, told me for a new In These Times article, "I don't disagree...There hasn't been enough attention to the ideas in [our] plan."

So what's the real story about Republican health plans?

Republicans have actually offered various bills, almost all emphasizing combinations of tax incentives, individual subsidies and vouchers that supposedly give individuals more control over their healthcare and promote portability of insurance, but they haven't united behind a single bill or set of core principles.

It's been well over 100 days since House Republican leader John Boehner and other House GOP leaders promised to introduce their own legislation.

The upshot of all the various plans, however, remains basically as Grayson described it: "Certainly from what I've seen of the 37 bills, the lesson is still 'Don't get sick,'" says Dr. Lesley Russell, a Fellow at the Center for American Progress who specializes in health policy. Indeed, as Think Progress summed up the view of progressive experts:

A close look at the GOP's so-called "principles" shows that they would break-up employer-based coverage, endanger the coverage of Americans with pre-existing conditions, and drive-up health care spending.

On top of that, several of the basic ideas in the various bills have been around for over a decade and could have been introduced in the Bush administration, if the GOP cared to do so. As one Center for American Progress memo noted, according to the Wall Street Journal:

Eight of the ideas have already been incorporated into Democratic legislation; five lie outside the jurisdiction of the relevant committees; and five have been around for more than a decade, so Republicans could have enacted them when they were in power.

In fact, as Russell found, despite complaining that Democrats have ignored their ideas only five provisions from the 37 bills were even offered by Republicans as amendments in any of the three House committees considering the Democrats' health bills.

Even if they're not serious about pushing for their own health reform agenda, American Progress's Wonk Room has highlighted their ostensible goals (as opposed to a possible hidden agenda of simply enriching health insurers):

These [GOP] alternatives claim to expand access by giving Americans a tax credit to purchase health care coverage outside of the employer-based system and control health care spending by capping awards for malpractice claims, and eliminating "waste, fraud, and abuse" from the system.

But perhaps one reason they haven't been pushed forward is that they could easily draw fire and raise alarms for potentially destroying employer-based care and wiping out Medicaid coverage for mothers and children.

Critics say they essentially force many workers and Medicaid recipients to fend for themselves with relatively modest tax grants that apparently don't cover even half the cost of premiums, nor effectively ban insurers' restrictions on pre-existing conditions.

My In These Times article looks at some of the risky or draconian provisions in major GOP House and Senate health bills, drawing on the research of experts at the Center.for American Progress, the Center for Budget and Policy Priorities and advocacy groups. What's particularly striking in some of the bills is how much they take dead aim at the fragile government safety net for the poor and aged -- as well as undermine employer-based health plans.

Take the purportedly well-meaning, sweeping ideas in the so-called "Patients' Choice Act," introduced by physician Sen. Tom Coburn (R-WI), among others.

It's especially troubling to critics that it would requires about 45 million non-disabled mothers and children to leave Medicaid and enroll in private insurance. "Our plan transforms Medicaid!" one Republican staffer told me.

Indeed, it does, but not in ways likely to appeal either to Medicaid recipients -- or those who care about public health and the needs of the poor. As the Center for Budget and Policy Priorities (CBPP) warned:

Plan Would Jeopardize Needed Care for Tens of Millions of Medicaid Beneficiaries

The bill's failure to make coverage affordable for many low-income people is especially serious because the bill would also eliminate Medicaid coverage for low-income children, parents, and seniors, pushing tens of millions of vulnerable people into the private insurance market. Low-income Medicaid beneficiaries tend to be in poorer health and are more likely to have chronic illnesses than people enrolled in private insurance; if forced to purchase coverage on their own, many likely would find the premiums unaffordable.

In addition, low-income seniors who are eligible for both Medicaid and Medicare would face substantially higher costs, because under the bill as drafted, Medicaid would no longer pay their Medicare premiums and cost-sharing.

On top of that, unlike those enrolled in employer-plans, patients in Medicaid auto-enrolled in private health insurance exchanges apparently couldn't return to Medicaid if they wanted to: they'd have to choose between private insurance companies in the exchanges and other companies outside the exchanges.

As their prescriptions and doctors' visits dry up during the inevitable snafus of waiting to transfer to coverage by for-profit private insurers, they'll graciously be offered "counselling" on their choices.

From the Republican perspective, this plan--which has already been rejected when offered as an amendment in the Senate health, education and labor committee -- isn't a Dickensian effort to rob impoverished mothers and children of affordable, accessible healthcare. Its announced goal is not just to put Medicaid on a sound fiscal path, but to "take the Medicaid stamp off their foreheads," as one staffer describes it, and allow recipients access to a broader range of care since as many as 65% of physicians don't participate in Medicaid.

The miracle of the free market would then be set into motion -- although this plan doesn't limit cost-sharing for the ex-Medicaid recipients or set meaningful minimum benefit standards tailored to the needs of low-income families and children.

But can't they just remain with their clinics and doctors in Medicaid? "They're not allowed to stay [in Medicaid]," a Republican staffer points out, excepting the disabled and the aged in long-term care. So much for the much-vaunted freedom in health care promoted by Republicans.

Senator Coburn and his co-sponsors, though, had a far sunnier view of their legislation when they introduced it in May:

Earlier today, U.S. Senators Tom Coburn, M.D. (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA) introduced health care reform legislation that delivers on the shared principles of promoting universal access to quality, affordable health care, and does so without adding billions of dollars in new debt or taxes.

"The Patients' Choice Act of 2009," transforms health care in America by strengthening the relationship between the patient and the doctor; using choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans. "The Patients' Choice Act" promotes innovative, State-based solutions, along with fundamental reforms in the tax code, to give every American, regardless of employment status, age, or health condition, the ability and the resources to purchase health insurance.

The CBPP's January Angeles has a far darker assessment:

Plan Fails to Create a Viable Alternative for People Losing Employer Coverage

Of particular concern, many of the people who would lose employer-based coverage would likely be unable to find affordable, comprehensive coverage on their own. The bill fails to address the significant shortcomings of the existing individual health insurance market that make it difficult for individuals who are older or have various medical conditions to obtain coverage...

Conclusion

The Patients' Choice Act is deeply flawed. It would likely cause many people who now are insured -- including millions of workers who are in below-average health and currently are covered through their employer, as well as millions of poor children and parents -- to lose their current coverage. In many cases, these people would end up uninsured, paying substantially more for insurance than they now do, or purchasing insurance that provides inadequate coverage and has high cost-sharing. The bill also would sharply increase costs for many low-income elderly individuals...

In other words, as Rep. Grayson said, it amounts to..."Don't get sick."

To read more, go to the progressive labor and reform blog, Working In These Times.

****************************
Art Levine co-hosts the Blog Talk radio show, "The D'Antoni and Levine Show," with Huffington Post blogger Tom D'Antoni, bi-monthly on Thursdays at 5:30 p.m. This week's guest is Nomi Prins, a Demos fellow and author of It Takes a Pillage, exposing the waste, greed and cronyism driving the economic meltdown and bailouts.

UPDATE: See Wanda Sykes take on GOP scare-mongering over "death panels":

 

Comments

[riffenberg]

· “From each according to his abilities, to each according to his needs.”
Karl Marx
Welcome to collectivism!
· For individuals making $34,140 (three times the Federal Poverty Level) the Baucus health care proposal could mandate up to $4,097 in annual premiums, a sum which could have been spent on over nine months of food, almost four months of housing or well over a year of utilities.
· For a family of four making $69,480 (300 percent above poverty) the Baucus bill mandates annual health insurance premiums of $8,338, which would be worth the equivalent of over 10 months of food, four months of housing or almost two years of utilities.
· For individuals earning $45,520 (400 percent above poverty) Baucus mandates $5,462 for health insurance, or over a year of food, four months of rent or a year and a half of utilities.
· For families earning $92,640 (400 percent above poverty) Baucus mandates $11,117 in health premiums, the equivalent of over a year of food, five months of housing or two years of utilities.”

Source: Report, “Potential Impact of Health Reform on the Cost of Private Health Insurance Coverage,” Pricewater­houseCoope­rs, October 2009.
http://www.ncpa.org/sub/dpd/index.php?Article_ID=18546

The DEMS are THUGS! They want nothing more than a govt. that is the equivalent to legalized mafia. If you disagree with them they will shut you up as they have tried to do with the insurance companies.

[tsobserver]

Republican­/Democrat. Two sides of the same coin. One will fleece you with taxes. The other will fleece you with debt. And even that line has been blurred so much that knowing the difference between the two parties has largely become an exercise in looking for the donkey or the elephant or an R or D next to a name below a face on the tube.

[jayjay4142]

I live in Alabama and I have been told that BCBS controls 95% of the insurance market here. What kind of competition is that?

[UKOH]

While I do think Rep. Grayson's attack was OTT - I deplore uncivil tones no matter what side they come from - like all good political satire it is effective because it has more than a grain of truth to it!

In contrast to "you lie" and the "death panel" stuff that has been debunked as pure politics with no basis whatsoever this one is appealing because it is but a slight exageration of what is actually true!

[mogens]

Seen from the outside you are trying to balance a pyramide on the top.
What about turning it around?
Some numbers: In 2003 USA used 1800 billion USD on health care. The overhead was 31% according to The New England Journal of Medicine, so the money used for health care was 1242 billion USD.
In Canada the overhead the same year was 16.7%, and the difference (311 billion USD) could easily pay for all the uncovered. Actually the total costs with a canadian model covering all would have been 30 billion USD cheaper in 2003 than the US model covering only 85% of the population.
In Denmark the health care costs in 2004 pc was about 4000 USD compared to 6000 USD pc in the USA in 2003, and in Denmark all is covered.
Make all education of medical personel (including doctors) free, then the doctors don't need those obscene salaries.
Every other model in the world today has a better cost/benefit ratio than the present US model, so apart from the immorality in treating health as a comodity intstead as a human right i´t is bad buisness.

[LuKennedy]

The overhead is going to be higher here no matter what we do. In Canada the population is only 33 million. In the US the population is 305 million. We require much bigger infrastructure. In fact, if we were to improve things here to the point where they meet foreign standards, our costs would double because the infrastructure would have to double. In the UK there are 1700 patients per general practioner. Here in the US there are over 3000 patients per general practitioner.

I agree with you that states should cover the cost of educaiton of medical personnel, and I think that in return doctors should serve 4 years as general practitioners, becuase honestly we don't have enough family doctors--all we have are specialists because specializing is where the money's at.

[mogens]

Actually the overhead should be smaller. When it is a percentage of the total costs, the problem with the different population size should be tackled. When you are more people, you should be able to make the cost pr unit lower.
The overhead pc in 2003 was 1860 USD in the USA, but 830 USD in Canada. That is a difference of more than 1000 USD or 217% of the canadian costs.
That should not be nessesary.

[LuKennedy]

By the way I just looked up the numbers for Canada where it looks like (in 2002) there are 1042 patients per general practitioner.

[bronceye]

It was sooooooo easy for the GOP to come up with the words,"death panel", as that is obviously their plan. I find that the majority of their accusations are merely projecting and deflecting.

[seted]

Want to visit Congressman Grayson's you tube page? Lot's of great videos.
http://www.youtube.com/user/RepAlanGrayson

[zwack000]

Everybody keeps saying that free markets and competition will contain costs and that there is no need for a public option.

There is a fundamental flaw in that logic. The health insurance industry is EXEMPT from monopoly and antitrust regulation. What that means is that they can dominate specific areas of the country (and they do) and undercut anyone else trying to enter the business making it impossible to insure true competition.

This exemption has been codified in federal law based on the insurance companies arguments that they need some massive critical mass to remain in business. It also coincidentally allows them to cherry pick clients and exercise abusive behavior and price increases with impunity.

In this kind of environment you need a nationally available health program to compete head to head with these monopolies.

If the insurance companies were to lose their antitrust exemption allowing other companies to form up and compete I can see a valid argument against the public option. By splitting them up into smaller units but with a larger available customer base with mandatory coverage requirements they should not then be able to run roughshod over the public for a necessary service.

I would still be a supporter of the public option independently finance by its customer base but my support would not be set in concrete.

[LuKennedy]

Healthcare this year is going to cost us $2.5 trillion. Half of that is medicare/medicaid, which the working public pays into in order to cover. The other $1 trillion is public cost. Do the math. The cost to cover the whole system is $8196.72 per person--that is if everyone including the elderly, poor, ill and children were paying in. There are only about 150 million workers. The cost per worker is actually $16,667. Every worker in one form or another is paying in 15.3% of their earnings to Social Security/ Medicare, and only 2.9% of that is medicare. Medicare is going under already because we aren't paying enough in to cover it. I get the feeling that most people think that insurance should work like magic. It is supposed to be a system for people to be covered in the event of a catastrophy, but people want it to be "cheap". If you are only willing to pay Wal-mart prices, you should expect Chinese coverage. I know that sounds awful, but as a nation we feel highly entitled to everything. We want everything, and we want it all now, yet we keep nothing and expect nothing (not even our marriages) to last a lifetime. We triple mortgage our homes(!) so that we can have everything we want, and then we complain when our "magic" fails us, the bubbles begin to burst and reality turns out to be all we're left with.

[awakening839]

My cost of insurance next year will go up 58% and has doubled in the 2 years since I retired. One of the reasons this has occurred is that my group of Pre-65 retirees is segregated from those yet to retire leaving a small group to pay for everything that happens.

[palou]

Boycot CHEVRON

[soma2005]

Can we please dispense with this tired old Republican vs. Democrat argument. Everyone knows that the insurance companies have rigged the game to their benefit. All the gains made by Democrats last year will evaporate from this toxic health care reform, but that's probably for the best as they have shown themselves as the spineless corporatists that they are, Obama included.

[dokeefenm]

It's true that many of the Dems are indebted to the insurance/health industry..but they are less so than the repubs. Who has tried to fix healthcare in the past? Any repubs? NO!! They aren't just beholden to the industry, they are in bed w/ it. If we don't know by now, repubs are essentially the party of big biz...it can do no wrong. Not small biz, mind you...the repubs do nothing for that segment. Many Dems do fight for working people against corporate power, and believe in the battle.
However, until we publicly finance federal elections, or ban all corporate influence in the electoral process,NO politician in America can be totally clean and independent. We do indeed have a corporatocracy, but the repubs are entirely bought and sold and the Dems still hold out frequently.
To lump the two parties together as equally bought and paid for by corps is simplistic and a sure way to keep the status quo.

[soma2005]

Actually, what Dems specialize in is creating the illusion of "holding out" and then when their end product is revealed, somehow the status quo is maintained after all. It's nice that some Dems "fight" but it'd be nice to see them win once in a while, but unfortunately they are a minority in the party. I'd bet there are about as many "independent" dems as there are republicans, both parties have outliers of course and they are seldom effective on either side. What's simplistic is to believe that either political party has your interests at heart, despite how much you want to believe that they do.

[soma2005]

See what happens with health care reform. If there is a real public option in the final bill, I will recant. If not, then we know that the Dems and Obama are playing us just like the Clintons did.

[PeterNY]

Wouldn't it be nice if the European governments competed for international health insurance and offered participating Americans discount prices on their national airlines? Flying to London or Paris would be a heck of a lot cheaper than getting stiffed by an American insurer and having to cough up $50 thousand to $ 200 thousand for a catastrophic illness. And just like the auto industry, the American health care goliath would have to deal with global competition. We might even live as long as the Europeans.

[Bush-Rolled]

Bravo!

[texfly]

You know, if you can wait for surgery, India is a good option. Round trip air, first class acommodations during recovery, very good hospitals, US trained Docs AND will cost less than here in the US

[ChelseaC]

Doctors are well trained in India too. India has fine medical schools.

[LuKennedy]

Most insurance companies are nothing but the hired bad-guys paid by employers to tell their employees the value of their health. I wish people understood this. The insurance companies are not the primary source of the problem. It's the employers who decide what those policies will and won't cover.

[ibsteve2u]

Don't you think that it is more accurate to say that health insurance companies offer businesses plans of varying expense, with the more thorough coverage being more expensive than the scantier coverage?

And once those papers are signed and the premiums are paid by the business, the insurance companies spend the rest of their contract commitment attempting to maximize their profits by weaseling out of paying for covered procedures?

Now if you'd said that the insurance companies provide an excellent route to bypass doctor/patient confidentiality through their informing of the "company nurse" or whomever reviewed insurance disbursements that so and so required treatment for such-and-such eventually disabling condition, and that knowledge might mysteriously impinge upon personnel decisions...that, I could have agreed with.

But as far as the business having veto power over procedures covered by a plan that they had already purchased...nah.

[LuKennedy]

When they set the standards for what they will and won't cover, they are set well in advance. The insurance company doesn't decide anything on a case by case basis.

For instance, last year my children had the state's children's insurance coverage offered through their schools. On the surface, the policy sounded decent enough and we couldn't afford family coverage (still can't, and we're self-employed, so there's not a lot of cost effective options). My youngest daughter got pretty sick when school started. she was running high temps and complained of her neck hurting. We took her to the only doctor we could get her into on short notice. He said he worried that it was meningitis and that he wanted us to go to the ER for her to be tested. The ER doc said he didn't think it was meningitis, tested her for everything else from strep throat to a urinary tract infection except for meningitis and sent us home with a prescription for amoxicillin before any test result was back. The bill was $1400. The state insurance paid for $87 of it (I think. Might have been a bit more). It wasn't as though someone sat down and said, "This kid doesn't deserve decent coverage." That's just hte way the plan was set up, and if I had gone and read the full policy, I would have known that before I paid for it.

[mhazard]

I don't agree. I worked for our local city hall and most of the workers are older and consequently have more health problems. Therefore, city hall has to shop around for a company who will insure higher risk employees at the lowest possible cost. It isn't easy.
Insurance charge a company based the average age of their employees. This is true of all companies shopping for insurance for their employees.

[LuKennedy]

Sounds to me like you were lucky to work for an organization that actually cares about the wellfare of their employees. Then again when you are talking about a whole workforce that is higher risk, it wouldn't be cost effective for any insurance company to cover them (no offense). Insurance companies may charge on the basis of average age of employees, but the companies you work for determine what coverage they want to supply. That is why one company might cover breast implants and erectile disfunciton drugs while another company might be hard pressed to offer breast exams and prostate screenings. It is up to the employer to determine what level of coverage they are willing to pay for--the level of worth of their employees. It is naive to point to the insurance companies as if they are villains when they are simply doing what they have been hired by your employers to do. That having been said, it is ludicrous to keep insurance tied to employment, but the movement away from that must be careful as well.

[57basque]

We might not have as big a problem if Unions had grown in membership since the 80s instead of being broken in the name of smaller Govt. Unions are the smaller Govt. which can solve things better than D.C. if Unions can get a living wage so people can take care of themselves as the right seems to say in their rhetoric.

[mhazard]

Thank you for this comment. The unions are ineffectual because they were broken during the Reagan administration with the air traffic controllers strike and the fear of people who need to have a job.

The unions are only as strong as the members. My son is a union member and he only goes to meetings to pay his dues. He never stays to see what is going on in within the union. I have told him that he needs to be more involved but it doesn't seem to mean anything.

People need to realize that the great prosperity that this country experienced during the 50s and 60s was only because of the efforts of unions. I admit that there is corruption within the unions, but once again I blame that on the apathy of the members. They need to get involved and know whats going on and correct it.
When a union is on strike, don't cross the picket line, no matter how much you need to shop at a particular store.

[Car84]

The air traffic controllers staged an illegal strike, and they knew it. Reagan did the right thing. (I'm in a union that cannot strike. I'd deserve to be shown the door if I broke that rule - fired by my employer, AND rightfully seen as a colossal failure by my spouse.)

Anyway, you're right about apathy, and putting faith in leaders that don't deserve it. Over the past decades, workers' interests have gotten closer and closer to those of employers, while the same old us-against-them model is still being used by some unions.

[Neopolitan]

Neither side has a Health Care plan that is easily understood by the American people nor do they have a financial forecast that will address how to pay for it. People with resources no matter how large or small are going to have to pay for those who have nothing. The question is - how much?

[debqd]

No problem. 85% for every dollar you earn over a $1 million. Send it in. Help you fellow Americans.

[mhazard]

Have you ever tried to read an insurance policy? Have you tried to read the bill, any bill, that is being proposed? I have and it's not easy.
People are, in general, obtuse. They want to be told what is in the bill. Nothing is written in a way that the average person can understand. Sorry to seem so stupid.

[Klimb]

I pay for school taxes yet I do not go school nor have children who do...somebody is always paying for someone else. Auto Insurance is same story, I pay my premium monthly and when somebody gets into accident with (even a DWI driver), the victim is compensated through whichever money I pay to auto insur. company...so we are always paying somthing for one another and it is not a crime BUT some would call it socialism? or a legal Ponzi?