Friday, December 03, 2010
Health Care: Can the GOP Prove it still has a Soul?
With Republicans poised to take control of the House of Representatives, there is little doubt that the recently-passed health care bill is up for, shall we say…”discussion.” The fact that Democrats continue to hold the Senate and White House also means that there is no run-away train here when it comes to passing – or repealing – legislation. A ‘divided’ government means that we can have two years of gridlock...or we can have statesmen from both sides of the aisle who actually work together to address the nation’s ills.
Eric Cantor, set to become the new Republican House Majority leader, has suggested in the last few days that the Republican Party, while looking to repeal “Obamacare,” may also offer revisions and additions to the bill rather than just repealing it and walking away. In this statement, there is the faintest glimmer of hope that America could actually end up with a better law.
Tea Party darling (and complete lunatic) Michele Bachmann (R-MN) has already gone on the offense, stating to the Christian News Service,
“…I think there needs to be an insurrection here in Washington, D.C., against our own [Republican] leadership, because that is the message that's come loud and clear out of this election: a full-scale repudiation and rejection of the federal government takeover of private industry…If we want to replace ["obamacare"] with Obamacare-lite where the government comes in and tries to have interventionist policies, we are going to continue to see failure…”
Bachmann represents everything that has gone wrong with the Republican Party: extremism, ignorance, mean-spiritedness, an elevation of ivory-tower theory over people and reality, and a slash-and-burn, rule-or-ruin style of governance.
For all its flaws, the Democrats got several things very right with the Health Care Bill: A new McClatchy Newspapers/Marist survey found that 68% of respondents favor allowing people under the age of 26 to be covered by their parents' plans, and 60% want to deny insurance companies the right to turn people down for coverage on the basis of pre-existing conditions. Permitting insurers to refuse coverage for pre-existing conditions is a pocket-lining win for corporate insurance at the expense of struggling families.
The entire theory behind insurance is that everyone goes into the ‘pool’, and those at greater risk are subsidized by ratepayers who pay more than they take from the system.
Seven hundred years ago, ship merchants in the Baltic Sea were besieged by Vikings; they got through that period by pooling their risk and cargoes, thus creating the first known insurance pool (The “Hanseatic League”). Those merchants who were set upon by Vikings were not ‘ruined,’ but rather, participated in the profits of the ships that did successfully reach port. That is the theory behind insurance: sharing the risk increases the chances that all will survive horrible mishaps. When Insurers are permitted to cut off newborn babies born with birth defects, or refuse to cover spouses with crippling diseases, they are throwing the ‘bad risks’ overboard; it is no longer an insurance pool, but a cartel of the healthy for the profit of the insurer.
Contrary to Bachmann’s blind quasi-religious belief in the existence of perfect markets in health care, we must acknowledge that there *is* a problem in terms of affordable access to health care for many Americans. With 10% of the Labor Force out of work, an additional 10% “underemployed,” and youth, stay-at-home parents, part-time workers, the disabled, many immigrants, and the homeless not included in those figures, estimates range from 30 to 50 million Americans living without health insurance. That means somewhere between 10% and 15% of Americans living on the edge of ruin or death at the instance of a single serious mishap or disease. The compassion of a civilized society rejects, "hell, tough on them!" as an acceptable response.
Republicans must be convinced to keep these two provisions of the health care bill, as well as an end to lifetime caps, or suffer the consequences at the ballot box two years hence.
In addition, this is an opportunity to make improvements to the existing bill. Those improvements could include the following:
1) Permit non-profit regional or state groups to form for the purpose of buying health insurance. Sounds simple, isn't it? But it's illegal under IRS Rule 501(m). Individuals can *not,* under existing law, form 'groups' whose primary purpose is purchasing group health insurance. (Groups may form for business or fraternal purposes, and then choose to buy insurance as an incidental benefit, but they can not form for no other reason than to buy insurance). End this prohibition, let competition ensue, and there will be no need for the single Federal Government Insurance company the Republicans fear.
2) End State-granted Insurance Monopolies. The Federal Government has the authority to regulate Interstate Commerce, and since people may get sick *anywhere* and request their insurer to cover it, this is clearly federal jurisdiction. Blow open the lid on Insurer Competition across state lines.
3) Enact Tort and Medical Malpractice Reform. It was reported 6 years ago that an OB-GYN doctor in Massachusetts has to deliver EIGHTY-FIVE babies just to cover malpractice insurance premiums for a year. Worse, 5% of doctors are responsible for 95% of malpractice claims, raising all doctor's and hospital's premiums. Limit Malpractice Awards, raise the negligence standards (so hospitals don’t need to run costly and unnecessary tests), and relieve the 95% of decent doctors from paying the premiums of the 5% convicted of malpractice.
4) Eliminate the FDA's Efficacy test, especially for terminal patients. Currently, the FDA requires that pharmaceutical companies prove that their drugs meet two tests: they must prove safe, and they must be 'efficacious,' that is, they must be proven to cure the condition they claim to address in virtually 100% of patients. This is a costly and inconclusive standard: people react differently to different substances. The peanut butter that fed me through high school will kill someone with an allergy; let *Doctors* decide what to prescribe, with the understanding that the idiosyncrasies of individual patients means that results WILL be different with different drugs. And while we’re at it, permit the medical production, possession, and use of cannabis.
5) Engage in Multi-national agreements with other nations to accept their pharmaceuticals and increase competition. The refusal of the US FDA to permit the importation of Canadian pharmaceuticals is insane. An individual can come to the US from France, or Britain, or Mali, or India, and providing only a driver's license from their own nation, get behind the wheel of a 6,000 pound rental car and take off minutes after landing - even if they don't speak English or have never driven on the right side of the road. And yet, if a pharmaceutical company goes through hundreds of thousands of test subjects in Germany, or Britain, or Canada, the results are not considered 'valid' in the US. Now, realistically, which is more dangerous: the driver, or a drug produced in Canada?
6) Permit every American to have a Medical Savings Account. Currently, Government workers and some self-employed people can utilize a Medical Savings Account which permits them to cover medical costs using a credit-card-like card. These citizens have a certain amount of money deducted from their paychecks, and go into an account for medical expenses: prescription drugs, eyeglasses, dental work, and even over the counter remedies. These deductions are pre-tax, meaning it lowers the person's gross income, lowering their tax and even possibly dropping them into a lower tax bracket. Better yet, these workers can 'borrow' against future deductions if they incur expenses early in the year at no interest expense. If government workers are allowed these accounts, why not ALL Americans?
7) Repeal DOMA and the Internal Revenue Service Imputed Income provisions. The Internal Revenue Service requires that employers report the value of health insurance benefits provided to non-traditional partners: registered domestic partnerships, civil unions, and some marriages. The value of this 'benefit' results in greater employee taxes - often as much as $3,000 annually. This creates a disincentive for employees in the majority of states where thee benefits exist to actually cover their partners...who then go uninsured, or who qualify for taxpayer funded low-income health programs in the states. ALL of these partners can be better served, with better insurance, at no taxpayer expense, if the IRS would stop punishing otherwise economically viable households based on their formal definition of 'federal marital status.'