In his address of October 30th, 2009, House Republican leader John Boehner R-OH criticized the Healthcare Reform understanding introduced by Nancy Pelosi, stating that it was a “government takeover of healthcare,” and “only Republicans have offered solutions to lower health care costs and make it easier to obtain quality, affordable coverage without imposing a massive burden on the American people.”
I for one am interested in his second point. What solutions is he referring to? Leader Boehner sums them up in four points.
1) Let families and businesses buy health insurance across state lines;
2) Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same procedure large corporations and labor unions do today;
3) Give states the tools to create their own innovative reforms that lower health care costs; and
4) End junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it’s good medicine, but because they are afraid of being sued
One such piece of proposed legislation is the “EMPOWERING PATIENTS FIRST ACT”, which includes coverage for all four of these points, and available here.
Let me start by making it clear that I am not necessarily for the 1,990 page behemoth that was introduced. I’ve worked in and around healthcare for 10 years. It’s a Jenga that requires the most delicate touch to handle, but I won’t be speaking from any position of authority on this bill. Ironically, no one else will either, because no one will read it except the authors. If you read 27 pages per hour without stopping for 3 days, you could get through it. Frankly, I mediate the bill should probably fail for that reason alone.
But the Republican party has a opinion too, so they say, and its so much easier to read. Tom Boehner says there are four key points. So lets look at the proposal briefly, point-by-point.
1) Buy across state lines. This is a pretty big regulatory order. I live in Seattle. I can’t currently bewitch a plan in South Dakota, no matter how good that plan is. The plan is not licensed by the state of Washington, for one, so that insurer can’t sell it here. Those regulations would be superceded by this legislation.
But there’s a much larger issue here. Why would I buy a view in South Dakota? This is just a guess, but I’m thinking that my proposed South Dakota plan would not have very many providers in my area of Seattle.
Why, then is this “state lines” argument even set forth? First, it sounds good. Seems to most people that the ability to remove another product means more competition, which is a good thing, right? Not necessarily. If you are shopping for a toaster, a bunsen burner sitting next to it on the department store shelf isn’t necessarily competition for your toaster dollar. Might do the same job, sorta. The same is true of my South Dakota plan. How long is their list of say, Seattle gastroenterologists, I wonder?
The genuine reason for this proposal is that insurance companies can offer inferior products across state lines that do not need to comply with the “secondary” state’s mandates. It’s determined to anyone reading this that there is little language that favors insureds and a tall deal of language that favors insurers.
2) Pool groups for discounts
Tantalizing that in a section titled Tax Incentives for Maintaining Health Insurance Coverage, we find abortion funding language. Way to slip that into the “pool groups for discounts” proposal. Now, whatever side of this issue you are on, this isn’t exactly a “bipartisan” topic, and slipping it in under the heading of “Tax incentives” should be an eyebrow-raiser.
Incidentally, there is a key reason the types of groups referred to in this section don’t exist. If you could get health insurance through your church, or through your alumni association, that would be awesome. Except… how would they collect the premiums? Non-employer groups have a huge difficulty with that. The reality of it is that the insurance company would need to collect the premiums from each person. Sounds rather like an individual health insurance plan, doesn’t it? There’s the rub. There isn’t really a “pooling for discount” effect here, and that’s why these groups don’t exist –because insurers recognize that these groups are a nightmare to manage. Employer sponsored insurance plans that are deducted from paychecks are the norm for a reason.
In addition, proposed legislation would make these groups “exempt from state benefit mandates.” That means that an insurer can offer a very stripped down policy with few benefits. Site mandates are created by the states for a reason. It is ironic here that this proposed legislation would actually bypass station control of health insurance, and location policy guidelines directly in the hands of the insurers.
3) Give states the tools to effect their possess innovative reforms that lower healthcare costs.
I like this idea. Other than the fact that the states already have those tools. They have insurance commissioners and they have regulations, they have mandates, and they regularly take insurance companies to task in order to ensure adherence to their guidelines. Actually this proposal limits some few states’ rights: The right to regulate plans sold in their states (but that originated in another state). The suitable to prohibit auto-enrollment. In the case of proposed IMA’s, the right to mandate that distinct benefits be a fraction of the plan.
Frankly, requiring states to track and go after insurance plans sold by resident insurers to individuals and groups in other states sounds like a regulatory nightmare for insurance commissioners. Oh, but they’d have the tools. This is rather like handing me blueprints to a Maserati, and complete access to all the tools I’d need to build it. Uh, thanks but no thanks.
The bill does subsidize and abet the development of state risk pools. This sounds rather democratic, but we’ll call it bipartisanship. Other than that, it actually does the opposite of what the Republican sponsors claim.
4) End Junk lawsuits.
Honestly, no one but lawyers want junk lawsuits. The conception of frivolous lawsuits in healthcare driving up our premiums by forcing doctors to spend more on malpractice insurance is infuriating. Unfortunately, this legislation does not address junk lawsuits. What it does is severely limit compensation available through legal channels to anyone who has been treated in a healthcare setting. It limits how much people can pick up when they sue. That’s not exactly the same thing as eliminating “junk lawsuits”. A patient can still sue for oh, say, a half a million, and though 90% of provider lawsuits are thrown out, the lawsuits might hold coming.
Good news, they only have three years to file a lawsuit, so that will help end those lawsuits by dumb people who wait more than three years. Or one year after discovery of the injury, or one year after they “should have discovered the injury”. Should have discovered the injury? Wha? Sounds like language crafted by and for lawyers. “Yes, your honor, but they should have discovered the injury more than a year ago.”
But I digress. What Obtain. Boehner really meant to refer to in his speech was “defensive medicine” –that doctors prescribe tests and procedures because they want to “CYA” (Cover Your Assets, shall we say). Reducing damages would, in theory reduce the fear-based medicine that the AMA believes accounts for between 80 and 154 Billion in healthcare costs every year(AMA 2009).
Still, if limiting damages, lowering liability costs, and helping doctors to practice medicine for the right reasons would be the net result, you have to like with this point.
Other stuff. This republican bill does a few good things mentioned above. It also contains financial back incentives for medical school. But it also throws in some other, more scary stuff. Here are a couple gems:
- Privatizing Medicare. “Yeah, lets let seniors opt out if they don’t need it, give them a tax fracture and let them acquire their own opinion in the private market. So few seniors really need health benefits anyway.” Try reading this on elder financial abuse.
- Establishing State Tribunals. I have a theory on this one: Lobbyist(pouring a drink): “you know what I hate? Judges. I wish we could just assign in a panel of doctors instead to hear cases. They’d be more sympathetic. Politician: Break out that bottle of 80 year old scotch and I’ll write it up!
You can’t call the Republican plan “all flash and no substance.” There’s a lot of substance. A lot of very bad, uninformed, insurance-company and lawyer-friendly substance. And while I haven’t started my 1,990 page book report, I am hopeful that it will read more like an Epic novel. This plan is unbiased a romance novel written in the 1800s. It has some spicy moments, but mostly its just trashy nonsense that very few people can really picture to.
Sources
“EMPOWERING PATIENTS FIRST ACT: A Solution from the Republican Study Committee for Access to Affordable, Quality Health Care for All Americans,” Price, Tom Chairman. June 2009. Accessed Oct 2009 at
http://rsc.tomprice.house.gov/UploadedFiles/Section_by_Section_EPFA_Final.pdf
“The Case for Medical Liability Reform,” American Medical Association, accessed at ama-assn.org October 2009. http://www.ama-assn.org/ama1/pub/upload/mm/-1/case-for-mlr.pdf
“Elder Financial Abuse Is Costly” Kahan, Stuart, Financial-planning.com May 8, 2009. Accessed October 2009 at http://www.financial-planning.com/news/elder-financial-abuse-costly-2661878-1.html
