Thursday, October 8, 2009

Actual Conservative Health Care Reform

Knowing that something happening is going to be better than nothing happening, I'll settle for some version of the Baucus health reform plan, though I'm not completely in favor of it. I'll side with heart surgeon and former senator Bill Frist on that. Ultimately, something as logical as the Healthy Americans Act isn't going to happen, and many provisions in the legislation - like preventing the insurance companies from dropping my family when they get sick - are good ideas. Beyond that, it's a good idea to provide a marketplace where Cigna or Kaiser or United have to offer a plan at a price - as opposed to charging me and my employer five times as much as they do for the same plan to a company across the street.

However, there are other ideas. And they don't have to come from the Democrats. I truly wish the GOP would actually start listening to the smart conservatives in their party and actually use some of the intelligent - not ideological - Republicans and conservatives to present an actual plan for health care reform. Not an idea or a theory or a ideology or a tweak. But an actual plan.

The simplest solution would be for the government to issue a health-care credit card to every family along with the insurance voucher. The credit card would allow the family to charge any medical expenses below the deductible limit, or 15 percent of adjusted gross income. (With its information on card holders, the government is in a good position to be repaid or garnish wages if necessary.) No one would be required to use such a credit card. Individuals could pay cash at the time of care, could use a personal credit card or could arrange credit directly from the provider. But the government-issued credit card would be a back-up to reassure patients and providers that they would always be able to pay.

The combination of the 15 percent of income cap on out-of-pocket health spending and the credit card would solve the three basic problems of America's health-care system. Today's 45 million uninsured would all have coverage. The risk of bankruptcy triggered by large medical bills would be eliminated. And the structure of insurance would no longer be the source of rising health-care costs. All of this would happen without involving the government in the delivery or rationing of health care. It would not increase the national debt or require a rise in tax rates. Now isn't that a better way?

That is market reform that would work, and it would actually accomplish the goal of many conservatives which is to encourage people to understand what their health care actually costs because they are paying for it - not $5 premiums for a high quality plan picked up by the wealthier companies and people in the country.

It's a thought. Any Republicans out there smart enough to run with this?


Brian Rude said...

I agree with you Michael. This proposal makes a lot of sense. High deductible insurance has always made a lot of sense, and that is the essence of Feldstein's proposal. If the government would simply provide everyone with high deductible insurance, and leave it up to individuals to figure out how to pay for routine health care, then normal market incentives would be restored to the health care market. It is the gross and tragic distortions of normal market incentives caused by generations of low deductible tax-favored insurance that has put us in the mess we're in today. Unfortunately the fix, though genuine and relatively easy, is going to be a hard sell. The general public doesn't understand it. Indeed the general public doesn't understand insurance in general.

Here's a link to an article I wrote over twenty years ago. The Trouble With Insurance I think it's as true today as it was then.

I disagree with you on one thing you say in your post. You say, "something happening is going to be better than nothing happening . . " I'm not nearly so optimistic. I'm rooting for nothing happening, on the idea that "something" will be considerably worse than nothing. "Something" will be government promotion of conventional insurance, and that will make things worse.

Daughter of Eve said...

*ahem* Any conservative who doesn't agree is then branded DUMB?? Thanks, I'm sure they all appreciate that.

mmazenko said...

No conservative is branded "dumb." There are plenty of conservatives in the GOP. Then, like all populations, there are some really "smart" people in this group.

Lately, though, it rarely appears that the main voices and faces of the GOP aren't listening to and promoting the ideas of the really smart people in their midst.

mmazenko said...

Thanks for commenting, Brian. And I really appreciate the link. This issue has been coming since Truman's time, and it should not be as convoluted as it has become.

Daughter of Eve said...

Mmm, well when you say smart you are implying that disagreeing parties are the opposite of smart, which is, of course, "dumb." If you wanted to say that YOU thought that they were EXTRA-smart, you could say "very smart conservatives." But the way you said it, "dumb" was implied. :P

mmazenko said...

I will concede that I am implying that not listening to very good ideas and instead listening to people like Glen Beck about an issue such as health care is not very "smart." And tens of millions do that every day. It's not very smart to willingly remain uneducated, quoting soundbites from Fox news and not actually addressing the problem, which is what many in the GOP are doing.

Lucy said...

You cannot generalize like that! MOST of the GOP are not doing that, maybe some are but that doesn't mean all the leaders only listen to Glen Beck for goodness sake! I don't think you consider yourself a republican. So to you of course you don't think they are VERY SMART, because you aren't part of their party. This seems kinda silly to me.

mmazenko said...

No, I'm not a Republican, but neither am I a Democrat. I have been both, and I left both parties after being disappointed by their leadership. I consider myself conservative on many issues, and I generally land in the moderate range for politics.

These days, however, I am far more disappointed in the Republicans for being a party devoid of ideas. They ran on a campaign that was, fiscally, last relevant in about 1984, and they have put for no realistic proposals for change in health care. In Colorado, they virtually bankrupt the state with naive tax and spending cuts, and this led Colorado to move from almost entirely Republican to entirely Democratic in six years.
Colorado is pretty conservative at time, but they are also pragmatic realists.

Thus, my conclusions about the GOP are drawn from poor decisions and lack of ideas among their leadership. While I don't agree with much that the Democrats do, I am shocked and disappointed by the foolish naivete of many speaking for the GOP.

So is the country. That's why the White House and Congress look like they do. Sadly, the Republicans who lost seats in Congress were the only ones in vulnerable districts, which meant the moderates. So a lot of smart rational Republicans lost their elections, and we're left with mainly ideological nutjobs like Michelle Bachman and Joe Wilson.

That's the problem.