Archive for the ‘Healthcare’ Category

The Elusive Reasonable Plan

Sunday, October 18th, 2009

In today’s Washington Post, there was a local opinion piece by John Hewko titled My Health-Care Story: Over 50 and Out of Luck. In it, Mr. Hewko states that he has “…just experienced first-hand our system’s dysfunctional wrath…”. He goes on to describe his situation which, in a nutshell, is this:

  1. Worked as a political appointee.
  2. Left government and became independent consultant.
  3. Insured through COBRA currently.
  4. Applied for individual coverage (nongroup) with CareFirst Blue-Cross BlueShield, which was the carrier that insured him when he was a federal employee.
  5. Denied coverage because of  borderline hypertension (that is controlled with medication) and mild stiffness in his left shoulder and right hip.

Mr. Hewko, who states at the very beginning that he is a Republican, spends some time chastising William Kristol for denying a health-care crisis. And this

No silver bullet will solve all our health-care problems, but four measures would address one of most glaring weaknesses of our system: mandatory insurance for all; subsidies for those who can’t afford the premiums; a prohibition against denying or rescinding coverage for “pre-existing conditions”; and meaningful tort reform. Yet Congress continues to make the ideological perfect the enemy of the desperately needed good. Democratic ideologues reject tort reform and insist on a public option that many suspect is a Trojan horse to a single-payer system, while their Republican counterparts deny that a crisis exists, decry any reasonable attempt at reform as a government takeover and fail to articulate an acceptable alternative.

I agree with Mr. Hewko’s prescription. In fact, it is virtually identical to what I suggested  here. But I think that Mr. Hewko is incorrect in his assessment of Republican views on reform.  Republicans enter the debate not hellbent on radically altering the system as currently experienced by most Americans. I believe that Republicans would like to focus efforts on the uninsured or underinsured, and I think they would like to address escalating costs. Let’s see the Democrats propose a plan similar to Mr. Hewko’s prescription, and then let’s take stock of Republican support before making the charge that Republicans “decry any reasonable attempt at reform”. In other words, let’s actually see a reasonable attempt.

Instead of reasonable attempts, we get unreasonable attempts. In the most recent proposal – the one that garnered a vote from the all-important Olympia Snowe – there are several fascinating assumptions that allow the CBO to declare that the proposal would reduce the budget deficit by $81 billion over 10 years and “continued reductions in federal budget deficits” in the years beyond.

One assumption is that it will be possible to find $500 billion in Medicare savings, presumably from fraud, waste, and abuse. Another is that tax revenues will increase because companies that provide “Cadillac” plans will, in lieu of paying penalties on those plans, reduce the quality of their plans and pay the difference to employees as taxable compensation. And, of course, many of the provisions of the Senate Finance Committee’s proposal do not kick in until after the next Presidential election. Right.

Reasonable Democratic Plans

Reasonable Democratic Plans

A Simple Rx for Healthcare

Saturday, August 22nd, 2009

It has been an interesting 4 or 5 weeks, watching the administration’s plans for healthcare reform (or is it health insurance reform?) implode. What makes this most interesting is the fact that everything is stacked in favor of the Obama administration. Large majorities in Congress, and a filibuster proof 60 votes in the Senate. And they still can’t deliver. Just like the Democratic congress could have halted funding for Iraq, but chose not to. I would think that the objective observer would agree that unhappiness with Bush and Republicans last fall had little to do with lack of healthcare reform. After all, the Bush administration worked with Congress to achieve an incremental improvement in the form of prescription coverage for seniors.

As a compassionate conservative, I have been somewhat sympathetic to the plight of the most unfortunate among us. Here’s how I would approach reform:

  1. Start with tort reform. There is no easier or quicker way to reduce the total cost of healthcare than by reducing or eliminating the ridiculous awards being handed out by juries like candy. And there is no easier way to indicate seriousness and a willingness to “spread the pain”. Plus, this will help get Americans off their notion that someone always has to pay if an outcome is poor.
  2. Require all Americans to have health insurance. As with auto insurance, if someone chooses not to have insurance, require that they pay into an “uninsured citizen” fund. Those paying into this fund would receive their basic healthcare services via Medicaid. Those truly unable to afford insurance should receive some type of tax credit or voucher from Uncle Sam.
  3. Eliminate pre-existing conditions (since everyone will be required to have insurance).

That’s it. The focus is on improving coverage, and not on “bending the curve” (aka cost savings). Anyone that has paid any attention at all to the cost of health insurance knows that many of the same concerns being expressed today were made 10, 15, even 20 years ago. Yes, healthcare costs go up more than the average. But something has to go up more than the average, right? This simply reflects supply and demand. And with baby boomers continuing to get older…well you can see where this is going. The Obama administration could consider addressing the cost increase by encouraging (through grants, say) more medical students to specialize in, say, family practice or in geriatrics.

I am amused every time I hear the administration trashing the insurance companies. The administration believes that a public option is needed “to keep the insurance companies honest”. Right. The fact that there are 1300 insurance companies does nothing for competition?

Liberals don’t want universal healthcare because they care so much for people. They want universal healthcare because they care so much for people’s votes. Give people healthcare, get their votes. How could I make such a grotesque statement? Simple. If liberals really were interested in keeping insurance companies honest, and spurring competition, and reducing costs, then why are they so fiercely against giving parents vouchers and a choice when it comes to education of their children? Apparently, there is no compunction in setting up a public option that has no bottom line profitability requirements to compete against the private insurers. But suggest that the private sector be allowed to compete against school systems that are top-heavy with administrators and that’s a no-go. It’s all about the votes.

The Democratic Healthcare Plank

Monday, November 10th, 2008

Healthcare is one of my favorite subjects.  As a compassionate conservative (no, really), I am disappointed that the world’s greatest economy (no, really) should have so many uninsured and underinsured.  I am in favor of providing some type of basic healthcare to everyone, but the devil is in the details.  I can remember when Bill Clinton won in 1992.  Although I did not vote for him, I was sort-of hoping that he would be able to do something with healthcare.

And this leads me to the real topic of this post. Democratic supporters have viewed healthcare reform (such as universal healthcare) as a realistically attainable part of the Democratic platform since Bill Clinton. The circumstances by which this has come to be are, I think, interesting and worth recounting.

H. John Heinz III (John Heinz) was a popular republican senator of Pennsylvania when he died in an unfortunate mid-air collision between a helicopter and the plane that he was in on April 4, 1991.  Incidentally, John Heinz was the husband of Teresa Heinz, now Teresa Heinz Kerry.

With the vacancy in the senate, the Pennsylvania Governor, Robert P. Casey, was required to appoint a replacement until a special election could be held.  After considering Lee Iacocca (who turned down the appointment), Casey selected Harris P. Wofford in May of 1991.

In a special election to be held in November of 1991, Wofford would face Dick Thornburgh, a former governor of Pennsylvania and U.S. Attorney General under Ronald Reagan and George H. W. Bush.  Initially, Thornburgh was so far ahead of Wofford that the election was almost considered a foregone conclusion. However, Wofford turned to little-known Paul Begala and James Carville as campaign managers.  It was during Wofford’s campaign that Carville first coined “It’s the economy, stupid”.  Wofford ran on a platform of universal healthcare and eventually won the special election by 10 points.

The amazing success of Wofford immediately catapulted Begala and Carville to national prominence.  Begala and Carville were then retained by the Clinton campaign as advisor and strategist.  In this capacity, they successfully transferred the issues that resonated with Pennsylvania voters – The Economy Stupid and Healthcare – to the national campaign.

It is interesting to trace the trajectory of Carville, Clinton, and universal healthcare to an unfortunate mid-air collision.  The political talents of Carville are immense, and voters have a healthy appetite for anything that appears to be free.  So I think it certain that universal healthcare would have worked its way into the Democratic platform somewhere along the line, regardless of the unfortunate events in April, 1991.  But when and to what extent?