After the President’s address, a couple of items from Pete Hoekstra and John Shadegg’s piece in last week’s WSJ stand out. Not least, will Pete agree?
The heart of their piece, the moment when they begin to actually talk about the real human need comes when they say
” no one should go bankrupt because of a chronic disease or pre-existing conditions like multiple sclerosis or breast cancer.”
This is real common ground, and a big applause line last night. The need is absolutely critical.
And let’s be clear, the record is clear. The August issue of the American Journal of Medicine reports 62% of all bankruptcies were due to medical costs, of those in bankruptcies, 75 percent already had medical insurance. The survey also found that 25 percent of companies terminate insurance immediately when an employee has a disabling illness. And yesterday’s Washington Post adds further fuel, noting that insurance companies have earned more than $300 million by selectively culling claims that filed – recission.
Bottom line: some sort of insurance reform is going to be required. Abusive contracts that place families at greater fiscal risk hardly deserve the name “insurance.” And I’m with McJoan at dailyKos, I wouldn’t especially call such insurance execs “friends.”
Build in Standards.
A second issue raised by the Hoekstra/Shadegg proposal is near and dear to conservatives. And like insurance, it carries the seed for something more radical.
” Our tax code incentivizes employer-provided health care, rewards health insurance companies by insulating them from accountability, and punishes those who lack employer-provided care.”
“We must stop punishing Americans who buy their own plan by forcing them to purchase their care with after-tax dollars, making it at least one-third more expensive than employer-provided care. Individuals should be able to take their employer’s plan, or turn it down and select insurance of their own choosing without any tax penalty.”
Talking point blather, perhaps? Then again, a study from Dean Baker’s CEPR brings up an interesting piece of information: the United States lags other developed nations in the proportion of its workforce in small, entrepreneurial businesses. The failure of affordable single payer insurance plays a part here stalls the economic engine.
But to make policies portable, to achieve the competitive ideal, they have to in one sense be comparable. Call it product protection, if nothing else. And the Elephants in fact are already looking at “exhange” – some marketplace of validated plans, plans that meet minimal standards of coverage, not least being free from the abusive contracts presently offered.
Insurance exchange. Minimum standards. There’s actually a phrase for it: Qualified Health Benefit Plans.
And Who’s in the Pool?
Hoekstra/Shadegg also revives a proposal from the Bush days (actually goes back further).
“State-based high-risk pools spread the cost of care for those with chronic diseases among all insurers in the market. The additional cost of their care is subsidized by the government.”
“Unfortunately, some states have not created high-risk pools, and some need to be restructured to ensure timely access to care. Republicans have proposed fixing this problem by expanding and strengthening this safety net, and by creating reinsurance or risk-adjustment pools so that Americans with chronic medical conditions can get the care they need at an affordable cost.”
Of course making subsidy of insurance rates the property of states would create a large set of unfunded mandates. Only 35 states have programs at all, and these of varying costs. The obvious problem is that states have differing levels of willingness or even ability to respond to these types of catastrophic needs.
The reality of varying state levels of support or ability to pay demonstrates why a national solution is to be preferred. As President Obama said:
“In the meantime, for those Americans who can’t get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it’s a good idea now, and we should embrace it.”
A John McCain idea.
In short the path to real reform is there, even in the Republican proposals. Of course one would never know it for the hysterics. Their failure is not in their plan. As shown, many are substantive and worthy of consideration. Rather the difficulty is a condition, a holdover from an earlier, less responsible era, where budgets and policy barely talked to one another. Hoekstra and Shadegg conclude:
“If we give citizens the ability to control their own care, cover pre-existing conditions, and provide resources to the uninsured, we will have fixed health care in America. No bureaucrats. No new czars. No mandates. Just choice and coverage for every American.”
And I want a pony, too.
As the Congressman will tell us elsewhere, we can not simply wish away our problems. Real problems require real lifting. It would be nice to have Hoekstra and Ehlers engage on this issue, but practical reality requires them to vote no, even when the ideas are theirs.
Filed under: Health care, National, Health care, Obama