Last week in the Coons-O'Donnell debate in Delaware, we heard the Republican candidate, Christine O'Donnell, lay out her answer to health reform -- or "Obamacare" as she and the Republicans so sarcastically call it. She cranked out two of the three talking points that Republicans have been spouting for over two decades: 1) Malpractice reform 2) Selling insurance across state lines and 3) Personal responsibility for care (translated means more of the "consumer driven" plans that have high deductibles up front.)
It's time to call them out. Since the Clinton health reform effort failed in the early 1990s, Republicans have been making these same points. They had eight years during the Bush Administration to show that these three talking points or "solutions" could make a difference. They did nothing about it. Why? Because these three talking points would make little to no impact on the real problems health reform is trying to solve. Here's why.
1) Take malpractice reform. Please. For years, studies have shown that malpractice reform, while desirable for a variety of reasons, would have almost no impact on the reduction of health care costs.
In fact a new study, published last week in Health Affairs suggests that costs associated with medical malpractice are far less than the $650 billion figure (26% of all money spent on health care) cited by some Republicans who have made tort reform a cornerstone of their vision for "bending the cost curve" in health care. The newly calculated figure, $55.6 billion, represents just 2.4% of health costs.
Reform the malpractice and medical liability system? Of course. But don't make it the centerpiece of a plan to reform health care. At best it's a byline.
2) Selling insurance across state lines? Republicans love this idea. Why? Because the very sleaziest of health insurance products and companies -- the ones that have such high deductibles you might as well not even have insurance ($5000, $10,000), what they call "catastrophic" plans, are just waiting for your state to allow them in, to sell you stuff that has almost no value. There has been legislation over the years to allow this sale of policies across state lines, but the conclusion is that it would little to no impact on the real problems we face.
As Ezra Klein pointed out in the Washington Post awhile back, this is a terrible idea.
As it happens, the Congressional Budget Office looked at a bill along these lines back in 2005. They found that the legislation wouldn't change the number of the uninsured and would save the federal government about $12 billion between 2007 and 2015. That is to say, it would do very little in the aggregate.
But those top-line numbers hid a more depressing story. The legislation "would reduce the price of individual health insurance coverage for people expected to have relatively low health care costs, while increasing the price of coverage for those expected to have relatively high health care costs," CBO said. "Therefore, CBO expects that there would be an increase in the number of relatively healthy individuals, and a decrease in the number of individuals expected to have relatively high cost, who buy individual coverage."That is to say, the legislation would not change the number of insured Americans or save much money, but it would make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance. It's a great proposal if you don't ever plan to be sick, and if you don't mind finding out that your insurer doesn't cover your illness. And it's the Republican plan for health-care reform.
3) Taking personal responsibility for your health? Wolf Blitzer asked O'Donnell last night if she approved of a person refusing to buy health insurance and then having the rest of us pay when that person gets sick and goes to the hospital. This is her non-response.
BLITZER: All right. Well, here's the question. Let's say someone decides not to purchase health insurance, makes that conscientious decision, even though this person can afford to buy health insurance, but decided he doesn't want to. This person gets critically ill, is rushed to an emergency room.Should we, people who pay for health insurance, provide him or her with that kind of treatment, or should we kick them out of the emergency room, said, you made a decision, you're not going to get this kind of treatment?
O'DONNELL: If we do the things that I've said that will help to address
-- that I'm proposing, that will help to address the issue of health care, then that person can afford to buy a catastrophic-only policy from across state lines. They'll be able...BLITZER: Well, what if the person doesn't want to buy it?
O'DONNELL: Well, then we have to address that.
BLITZER: Who should take care of that person in an emergency?
O'DONNELL: We have to address it.
BLITZER: Would we, all of us tax-payers...
O'DONNELL: We have to -- no, we have to...
BLITZER: ... have to pay for that person?
O'DONNELL: Anything that they do when they have another bill that they can't pay, make them pay it. Hold them accountable for that.
KARIBJANIAN: Before or after they get care?
O'DONNELL: But right now, right now -- well, that's up to the hospital.
But right now we're forcing them to. We're forcing them that they have to give care to illegal aliens...O'DONNELL: Well, nobody should be forced to pay for anyone else's health care, and that's what Obamacare is doing.
COONS: And that's what's happening today. Before the health care reform bill passed, all of us who have health insurance, who have health coverage have been bearing the costs, paying the freight for those who don't have insurance and don't have coverage. They're getting health care through emergency rooms now. That's partly why small businesses, employers like New Castle County have faced double digit increases in our insurance costs year after year and year because that's how we provide care now, it's inefficient, it's inhumane and it's not effective.
Note that Chris Coons nailed that answer and O'Donnell unwittingly agreed with him.
This is the Republican answer to "personal accountability." If O'Donnell knew more, she would know that hospitals have to write off the care of that type of person, and when they do, they shift those costs wherever they can -- mainly to those of us who are paying customers. Personal accountability is fine if you have an extra $100,000 around to pay for your health care if you are uninsured and get sick. But if you don't, you lean on the rest of us.
O'Donnell missed the third and main Republican talking point on personal responsibility -- and that is the sale of consumer-driven or consumer-directed health plans, where the high up front deductible is meant to discourage people from seeking unnecessary care. Not a bad idea if it's a choice for people. If they have enough money to pay those deductibles before they get the care, fine. But it has been shown that consumer-driven products tend to work better with higher income consumers, and consumers tend to delay care when they enroll in those plans. The American Academy of Family Physicians offers this analysis:
A December 2005 survey by the Employee Benefit Research Institute (PDF file: 12 pages / 163 KB. More about PDFs.) notes that patients with consumer-directed or high-deductible health plans "were significantly more likely to avoid, skip or delay health care because of costs than were those with comprehensive insurance, with this behavior particularly pronounced among those with health problems or incomes under $50,000."
So that's the Republican Plan for reforming health care and lowering costs. As you listen to the debates in the next few weeks, raise a glass every time you hear those talking points (but be careful to drink something non-alcoholic or you'll pass out). And remember -- as complicated as health reform is -- and it is too complicated for three talking points -- it is the Democrats who attempted to really solve these problems and will continue to work on this year after year until all the wrinkles are ironed out. (By the way, might I note that reform has NOT yet been implemented fully and won't until 2014, so could the candidates please stop blaming reform for everything that is happening now?)
Slogans are easy to spout. Real reform is a lot harder.
UPDATE: In the debate between Harry Reid and Sharron Angle in Nevada, Ms. Angle mentioned two of the three Republican talking points as her solution -- malpractice reform and selling insurance across state lines. Have a drink everyone!!
From what I see, it's a tricky situation in the US. The common denominator is that US health insurance companies seem for lack of a nicer word: evil.
Option 1. Status quo
Option 2. Obamacare
Option 3. Dismantling the health insurance industry and creating a socialized health care.
Option 1 sucks. Option 2 definitely has its downside. Insurance companies need to be reigned in further. Option 3 is destroying a whole industry.
It's not an easy answer for my American friends.
It's easy for me, but that has been a legacy that was passed down to me.
Caitlin Kraft Buchman: Switzerland's Health Insurance Providers are Non-Profit: That is the Only Reason Their System Works, Period.
"...So I won't get into the obvious. I did however want to remind you that the Swiss system of mandatory health insurance only works because health insurers are forbidden to make a profit on basic health insurance coverage!
But don't worry. Our insurance companies are in quite healthy (ha, ha) financial shape. Really.
Everyone in Switzerland carries two government mandated policies - 1. personal everyday medical health insurance ( with lots of choice regarding add ons and deductible), subsidized by the government for those in need, and - 2. accident medical insurance, half paid for by one's employer, half paid for by employee, or when necessary the state. (This is a relatively inexpensive subsidy for a country with unimaginably low unemployment).
That health insurance is competitive and non profit is built into this very capitalist and working Swiss system, a system that believes no one should go bankrupt and lose their home because of family medical bills, that no one should delay critical medical and preventive care, and lose even their health because they are uninsured, and that no one should lose their life because an insurer denied coverage due to any pre existing condition. This is a competitive capitalist system that says no one should go without health care if they need it...."
It's good of you to have confirmed what I thought was Fox-generated propaganda. I'm still, myself, for single-payer (medicare for all), and I can't wait until the day when this country comes to its senses, and adopts what the rest of the civilized world has had, successfully, for decades: universal, affordable (not for profit) primary health care.
It is imperative we bring in those who are uninsured, and mandate health insurance for all. For our very survival in this conpetitive world of finance, any thinking person knows we must have a health insurance program at least as enveloping as other countries we trade with in order for us to thrive.
Those that are bound and determined to fight any reform, will bring this country down. Instead, they should be addressing the problem and working with this administration to improve what we have now. Yes, we must bring everyone into the pool; that is the only way to bring costs down and keep them down.
If the GOP really is on the side of doing what is vital for our recovery as a nation, our sustainability, and our very future as a leader nation, they must stop this partisenship and do the right thing. The health industry will survive, will we?
Europe, Canada and Australia have lots of both. But, less illegals because they're willing to enmforce it, particularly against companies who hire illegals ( a side benefit of their strong Unions). Even so, do you really believe "illegal immigration" causes helath insurance companies to raise premiums 30& a year? By the way, I simply don't believe your "real life example" is stating all the facts.
My wife's Canadian, her mom lives there, is 75 and needs periodic medical care. No problems, and she isn't worried that medical care will bankrupt her.
It is too bad many in our culture equate providing basic human needs to all Americans as somehow wrong. Instead of looking at it as something to abhor, it might behoove us to rethink how this country would move ahead if our nation stood up for all its people in the way of health care, education, with a sense of well-being. Americans have always been innovative and there is so much we have to contribute to this new world of alternate energy, and competition in our global society. How can we push forward, if many of us are always worried about our general welfare.
I'm using Germany as an example, because they have a large ethnic diversity compared to their size, they have ethnic Germans, as well as Muslim Turks who were brought in as guest workers and have stayed, and others. The literacy rate in Germany is 99%, according to one source I read.
We seem to be fighting a policy that would be good for America. We must get over this notion that everything that will benefit people is bad, and too European. We are being stubborn and pigheaded.
Yes, this is actually a complicated topic.
Thanks for adding to the "marketplace of ideas!"
physical responsibility for taking care of themselves.
You sound like another controlling republican who wants to tell other people what to do/how to live as you scream for smaller govt.
You probably already know about this:
http://www.manufacturingnews.com/news/10/0518/chinadrugs.html
You Don't Know Where Your Drugs Come From And Neither Does The FDA; U.S. Imports 90 Percent Of Its Antibiotics (And Vitamin A) From China
Think about all the advertisements you see today on tv. Lawyer firms saying if you had this or you had that, please call us. They are making a killing and if it would save 2.6% of the cost on all of us forcing doctors to have to insure themselves to the max, so they could lower their rates, hell yes. That's just one part.