The Republican Alternative To “ObamaCare” Is ObamaCare
On Saturday, David Fahrenthold wrote that “more than a year after Republicans first pledged to ‘repeal and replace’ President Obama’s new health-care law, the GOP is still struggling to answer a basic question. Replace it . . . with what?”
This shouldn’t be such a problem. Health care is a big issue. It’s been around a long time. The Republican Party should, in 2011, have a position on it. To understand why it doesn’t, it’s worth reading Newt Gingrich’s April 2006 comments on then-Gov. Mitt Romney’s Massachusetts reforms.
“The most exciting development of the past few weeks is what has been happening up in Massachusetts,” wrote Gingrich, or someone speaking for Gingrich, in his “Newt Notes” newsletter. “The health bill that Governor Romney signed into law this month has tremendous potential to effect major change in the American health system. We agree entirely with Governor Romney and Massachusetts legislators that our goal should be 100% insurance coverage for all Americans. … Individuals who can afford to purchase health insurance and simply choose not to place an unnecessary burden on a system that is on the verge of collapse; these free-riders undermine the entire health system by placing the onus of responsibility on taxpayers.”
In 2006, in other words, the Republican Party had an alternative to Obamacare. The only problem? It was Obamacare.
Between 1990 and 2007, the reigning Republican theory of health-care reform was that instead of handing the health-care system over to the government, they would put private insurers and personal responsibility at the core of their health-care reforms. During this period, everyone from Bob Dole to Jim DeMint to the Heritage Foundation endorsed this approach. But then Democrats, looking for a compromise, endorsed those same plans. And then Republicans, rather than pocketing the policy win, ran from their own ideas.
But insofar as the Republican Party had a plan for health-care reform, the individual mandate was it. That’s why Mitt Romney, Newt Gingrich, Tim Pawlenty, and Jon Huntsman either passed, endorsed, or expressed openness to an individual mandate. And that’s why Romney hasn’t paid for his plan: Almost every other serious candidate for the Republican nomination supported an individual mandate, too. It’s hard for Gingrich to take a clear shot at Romney for proposing what Gingrich called “the most exciting development” in health-care reform.
It’s also why the Republican Party can’t figure out an alternative to the Affordable Care Act. The Affordable Care Act was their alternative. Now they need an alternative to the alternative. But there are only so many policy approaches that make sense as an answer to our health-care problems. And Republicans have pretty much run out of them.
By: Ezra Klein, The Washington Post, December 27, 2011
Texas-Style Tort Reform: Rick Perry’s Texas Health Care Hoax
In his quest to win the Republican presidential nomination, Texas Gov. Rick Perry is perpetuating a convincing hoax: that implementing Texas-style tort reformwould go a long way toward curing what ails the U.S. health care system.
Like his fellow GOP contenders, Perry consistently denounces “Obamacare” as “a budget-busting, government takeover of healthcare” and “the greatest intrusion on individual freedom in a generation.” He promises to repeal the law if elected.
Unlike those in the “repeal-and-replace” wing of the Republican Party, however, Perry has emerged as leader of the “repeal-and-let-the-states-figure-it-out” wing that believes the federal government has no legitimate role in fixing America’s health care system.
“To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution — if any — they may eventually provide,” Perry wrote in a newspaper commentary in 2009. “I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.”
Even as he points with pride to the alleged benefits of malpractice and other tort reforms that have been enacted during his tenure as governor of Texas, Perry says he is opposed to tort reform at the federal level. He cites the 10th Amendment to the Constitution, which states-rights advocates say limits the role of the federal government.
But if Perry had his way, all the states would do as Texas did in 2003 when lawmakers enacted legislation, which he championed, limiting the amount of money juries can award patients who win malpractice lawsuits against doctors and hospitals. The legislation capped non-economic (pain and suffering) damages at $250,000 in lawsuits against doctors and $750,000 against hospitals. A few months after he signed the bill into law, the state’s voters narrowly passed a constitutional amendment, also endorsed by Perry, which had the same effect. Proponents of the amendment wanted to be sure the new law would be constitutional.
Texas, he wrote in that 2009 commentary “stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.”
As a result of the 2003 tort reform law, malpractice liability insurers reduced their rates in Texas and, according to Perry, the number of doctors applying to practice medicine in the state “skyrocketed.”
He says that in the first five years after tort reform was enacted, 14,498 doctors either returned to practice in Texas or began practicing there for the first time.
Tort Reform Backfires in Texas
That certainly sounds impressive — so long as you look at that number in isolation. But when you look at how Texas stacks up with the rest of the country in terms of physician growth in direct patient care, tort reform appears to have given Texas no leg up in competition with others states for doctors. In fact, according to statistics compiled by the American Medical Association and other physician organizations, Texas has actually lost ground when it comes to the number of doctors practicing in the state since tort reform was enacted. Big time.
In 2008, the number of physicians in patient care per 10,000 civilian population in the United States was 25.7. At just 20.2 doctors per 10,000 people, Texas ranked near the bottom of the 50 states. In fact, only nine states fared worse. In 2000, three years before tort reform, Texas was still bringing up the rear, but not as badly. Back then, 11 states fared worse than the Lone Star state.
Even more revealing, the number of doctors in patient care increased 13.2 percent nationwide from 2000 to 2008. It increased only 12.8 percent in Texas. The rate of growth was actually greater in 41 other states and in Washington, D.C. than it was in the Lone Star state.
It is true that malpractice insurance rates dropped in Texas after tort reform was enacted, but Texans would be hard pressed to claim any direct benefit from that drop — except, that is, Texans who are doctors.
The Dallas Morning News published a chart earlier this year showing that the average malpractice rate charged ob/gyns in Texas by the state’s largest domestic insurer of physicians fell from $53,752 in 2003 to $33,881 in 2011. The paper reported drops of similar percentages for doctors in family practice and general surgery.
Advocates of tort reform have long claimed that one of the reasons for escalating health care costs is the “defensive medicine” doctors practice, such as over-treating and prescribing more medications and diagnostic tests than necessary, out of fear of being sued. Well, if Texans believed their own health insurance rates would go down once tort reform made defensive medicine less prevalent, they have by now been disabused of that notion. The chances of a Texas family saving a few bucks on premiums would actually be greater if they moved to another state.
In 2010, the average premium for family coverage in Texas was $14,526. That’s $655 higher than the U.S. average. Those numbers seem to indicate that doctors have not passed on their own insurance savings to their patients and that they are not practicing medicine any less defensively than before tort reform was enacted.
Not only are Texans paying more for their own insurance while doctors are paying less for theirs, their chances of getting employer-subsidized coverage is less than it would be if they lived in another state. The Dallas Morning News, citing statistics from the Agency for Healthcare Research and Quality and other sources, reported that a smaller percentage of employers in Texas offered coverage to their workers last year than in the U.S. as a whole (51 percent and 53.8 percent, respectively). And the Texans who do have coverage through the workplace are contributing far more out of their own pockets for that coverage than people who live in most other states. In Texas last year, the average employee contribution toward company-sponsored coverage was $4,500. The U.S. average was much lower: $3,721.
Another statistic Perry is not likely to mention when he talks about the benefits of tort reform is the number of Texans who are uninsured. The U.S. Census Bureau reports that Texas continues to be the state with the highest percentage of its residents without coverage, a whopping 25 percent last year, compared to about 16 percent nationwide. It was dead last in 2003 and it is dead last now.
All this should leave us wondering what “thing or two” states have come up with to solve the problems that affect their citizens. Considering the dismal state of health care in Texas, perhaps Perry had Massachusetts in mind.
By: Wendell Potter, Center for Media and Democracy, September 1, 2011
GOP Has 2012 Trouble: Attacking Medicare And Social Security Could Be Death Of Republicans’ 2012 Hopes
Recent weeks have finally defined the race for the 2012 Republican presidential nomination. The field has finally achieved a greater level of clarity as many candidates have opted out, running the absurd-to-formidable gamut from Donald Trump to Mitch Daniels. A smaller number have opted in, running the has-been to may-never-be gamut from Newt Gingrich to Tim Pawlenty, not to mention former Massachusetts Gov. Mitt Romney, who officially entered the race yesterday.
A former Minnesota governor, Pawlenty officially joined the wannabe ranks last week with a speech aimed at defining himself as a fearless teller of hard truths (previously he had perhaps best been known for lacking any definition at all). This is smart on several levels. He quickly moved to fill the void left by Daniels, the governor of Indiana, whom many in the party had yearned for as a tough-minded fiscal hawk. And in part it is a strong bid for the mantel of not-Romney, the alternative to the former Massachusetts governor and current GOP front-runner. Romney is a laughably transparent flip-flopper, so Pawlenty’s new truth-teller frame could make him an ideal foil.
Politicians love to position themselves as tellers of hard truths, brave enough to boldly level with the voters. And the current tempestuous political climate, with its roiling discontent with politics as usual, especially lends itself to such a pose. Pawlenty is merely the latest candidate to seize this meme.
But his candidacy runs squarely afoul of Robert’s 13th rule of politics: People like the idea of hard truths and hard-truth tellers much more than they like the reality of them. You can ask straight shooters like Walter Mondale (“Mr. Reagan will raise taxes, and so will I. He won’t tell you. I just did.”), Paul “I’m not Santa Claus” Tsongas, and John “Straight Talk” McCain. Winning the presidency requires an aspirational element at odds with the doom-and-gloom that comes with those self-consciously trying to speak hard truths.
So kudos to Pawlenty for standing up to big ethanol in little Iowa. But while some may take off their hats to him for traveling to Florida in order to call for overhauls (read: cuts) of Social Security and Medicare, it might be merely to scratch one’s head. As Hot Air blogger Allahpundit quipped after Pawlenty’s Florida performance, “Alternate headline: ‘Pawlenty now unelectable in not one but two early primary states.’ ”
Maybe this is actually deep strategy. Many conservatives and Tea Partyers in particular seem intent these days on—as Ronald Reagan used to complain of some of his more gung-ho supporters—going “off the cliff with all flags flying.” Perhaps this is a clever way for Pawlenty to appeal to that “I’d rather lose being right” instinct.
An additional problem for would-be hard-truth tellers is that in the telling, these so-called truths often become vehicles for an even harder ideology. The attempt to conflate serious problems with ideologically inflexible and partisan solutions can create political tensions and open deadly political rifts. See the political abyss House Budget Committee Chairman Paul Ryan has marched his colleagues into over his plan to repeal and replace Medicare.
With the future insolubility of Medicare as a starting point, Ryan and the GOP have embarked on an emphatically ideological course. They hailed themselves as seriously facing a tough issue, and they spin the plan as an attempt to save the program, but all it would save would be the name “Medicare.” A guarantee of healthcare would be replaced with a voucher of diminishing value. If it fails to cover seniors’ costs . . . tough luck. The view was perhaps best summed up by Georgia GOP Rep. Rob Woodall, who chastised a constituent at a town hall meeting last month when she asked how, after Ryan’s reforms eliminated the guarantee of Medicare, she could expect to get medical coverage since she worked for a company that doesn’t offer it in their retirement package. “Hear yourself, ma’am,” he said. “You want the government to take care of you, because your employer decided not to take care of you. My question is, ‘When do I decide I’m going to take care of me?’ ”
Woodall, like many conservatives, fails to grasp why programs like Medicare were created. They were a response to a market failure—specifically an inability of senior citizens to get or pay for healthcare. But in Woodall’s world there are apparently no market failures; if seniors can’t get healthcare it’s because they simply won’t take responsibility for themselves. Of course in 1964, 44 percent of senior citizens had no health coverage, and the cost of medical bills had driven more than one third of them below the poverty line. If only they had had the moral fiber to take care of themselves!
Safe in a heavily conservative district, Woodall can spout such nonsense. But roughly 60 House Republicans represent districts Barack Obama won in 2008 and virtually all voted for the Ryancare overhaul. In this case, the gap between hard truths and hard ideology may be big enough to swallow a House majority.
Just ask the pollsters employed by the House GOP, who warned that the bill was a ticking time bomb, Politico reported last week. Or ask Jane Corwin, that bomb’s first casualty. She is the Republican who lost May’s special election in a GOP-leaning New York district in which the Ryan plan was the defining issue. Or ask Sens. Olympia Snowe, Susan Collins, Lisa Murkowski, and Scott Brown, four of the five Senate Republicans who fled the plan last week (the fifth, Rand Paul, opposed it as not being conservative enough).
Or ask Gingrich, the former House speaker who drew party-wide opprobrium when he dismissed the Ryan plan as being so much “right-wing social engineering.” Pity poor Newt: He was just trying to tell a hard truth.
By: Robert Schlesinger, U. S. News and World Report, June 3, 2011
In This Fantasy Budget Deficit And Debt Fight, the Tea Party Refuses To Take ‘Yes’ For An Answer
Suppose I told you that I knew of a simple way to alleviate the budget deficit problem, and that it would require Congress not to do anything at all. You’d conclude that this was the poor start to a late April Fools’ column.
But unhappily the April Fools’ joke unfolding in the nation’s capital is the fantasy budget and spending debate itself. It’s rooted in an unreality that is about to crash into an unyielding real world, possibly in the form of a government shutdown.
The Congressional Budget Office, a nonpartisan fiscal scorekeeper, projects the budget deficit will be $1.5 trillion this year, or 9.8 percent of gross domestic product. In order to achieve budget stability and sustainability, according to economists, that figure should be around 3 percent of GDP. But here’s the good news: The CBO projects that the deficit will “drop markedly over the next few years as a share of output and average 3.1 percent of GDP from 2014 to 2021.” We’re saved! And it gets better: “Those projections . . . are based on the assumption that tax and spending policies unfold as specified in current law.”
In other words, all Congress has to do is what they seem ideally suited to these days—nothing. Ah, but there’s the rub. CBO continues that its projections “understate the budget deficits that would occur if many policies currently in place were continued, rather than allowed to expire as scheduled under current law.” Those policies include the Bush tax cuts. They also include annual spending punts that enjoy broad bipartisan support, like preventing the Alternative Minimum Tax’s bracket creep from snagging the middle class, and the “doc fix,” which pushes back a scheduled cut in Medicare payments.
So the solution isn’t so simple. But lawmakers wishing to do more than talk about dealing with the deficit could demand offsets for these policy changes. Instead, we’re reminded of the reality that even the toughest self-styled budget hawks–including Budget Committee Chairman Paul Ryan, who describes dealing with the deficit as a “moral imperative” but advocates extending the Bush tax cuts in full in perpetuity at a cost of nearly $4 trillion–are actually strutting budget peacocks more concerned with perception than results, or fiscal results anyway.
Take, for example, the Republican Study Committee, the hawkiest of the GOP budgetary birds of prey and enforcers of the party’s economic dogma. Going by reputation, they should be able to proffer a budget plan to bring the deficit into line. But the Concord Coalition, a group focused on eliminating the deficit, last month used CBO numbers to examine a scenario under which the Study Committee got its tax-and-spending wish list, which includes an extension of the Bush tax cuts, repeal of the Obama healthcare law (which CBO scores as a money-saver, meaning that repeal adds to the deficit), and $2.7 trillion saved in a spending freeze and cuts. The result? “Under this scenario, the resulting deficits would be $2.1 trillion larger over 10 years,” according to Concord, which concludes, “A budget that uses honest numbers and reflects Republicans’ current policy preferences will result in large continuing deficits.”
But nevertheless, and in the face of six recent years of GOP control over both the White House and Congress, Republicans have won the budget perception battle, and soundly. A poll released last week by Democracy Corps, a group of prominent liberal pollsters including Stan Greenberg and James Carville, found that independent voters are “still hesitant to trust Democrats on spending.”
Meanwhile the debate in Washington has focused almost entirely on spending cuts, even though polls show that voters are more concerned about jobs and the economy than the budget and the deficit—and even though most economists agree that the GOP’s proposed spending cuts would set back the recovery.
But the clearest example of the GOP having the Democrats on the run can be found in the current negotiations aimed at averting a government shutdown in a week. House Republican leaders originally wanted $32 billion in spending cuts for this year; that figure prompted a conservative backlash that ended with the House passing $61 billion in cuts. Now, according to press reports, negotiators have settled on $33 billion in cuts. In other words, the GOP, which controls one of three players in this negotiation, has already achieved its original budgetary goal. In this regard, House Speaker John Boehner seems to have (intentionally or not) used his Tea Party wing as a perfect foil to pull the debate to the right.
But judging by last Thursday’s Tea Party demonstration on the Hill—aimed at the GOP, mind you—conservatives don’t seem capable of banking their win and moving on to the next fight. They see anything less than total victory as an abject surrender.
And in that sense reality is about to intrude upon their budgetary-political fantasy land. The reality is that while voters like spending cuts in the abstract, polls show they object to the particulars of the GOP agenda. That reality is already taking hold at the state level where, Politico reported last week, the wave of newly elected governors trying to get tough on budgets have seen their approval ratings collapse.
And the experience of state governments also provides an insight into the possible winners and losers in a government shutdown. A pair of political scientists published a paper last year looking at the effects of such budgetary breakdowns (167 of them since 1988) at the state level, reports the Washington Post’s Ezra Klein. The study found that voters tend to punish legislators while rewarding the executive. So a shutdown would benefit President Obama while hurting lawmakers in both parties.
So if members of Congress let the government shut down on Friday, they will be the real April fools.
By: Robert Schlesinger, U.S. News and World Report, April 6, 2011
The Affordable Care Act, One Year Later
A year ago this week, Capitol Hill was full of noise as the House of Representatives debated, and then voted, on the Affordable Care Act. But one of the most vivid memories of that experience for me was an extended moment of silence.
It came very late on Sunday evening–after the floor speeches, the votes, and the press conferences had ended. The galleries had long since emptied and the Capitol building itself was virtually unoccupied, so that it was possible to walk the entire length of the building, on the ground floor hallway that stretches from the House all the way to the Senate, without hearing so much as a single conversation.
It felt more than silent. It felt peaceful and, yes, satisfying. A prolonged, difficult debate had finally ended. It was time to move on.
Except that we haven’t moved on. We are still having arguments about health care reform. In fact, we are still having the same arguments about health care reform. The Affordable Care Act is law of the land now, yes, but its critics are determined to change that. And while the prospects of repealing it legislatively remain relatively slim, the prospects of repealing at least part of it judicially seem far more realistic than they did in the spring of 2010.
So perhaps it is worth taking a step back, just for a moment, and remembering how we got to this point–why this debate started in the first place and why it led to the enactment of this law.
It’s really not that complicated. Around one-fifth of the non-elderly population, or somewhere in the neighborhood of 50 million people, have no health insurance. Many millions more have insurance with major gaps or limitations, leaving them at risk of financial or medical catastrophe. Notwithstanding legitimate debates over exactly how many people go bankrupt or suffer physical hardship because they can’t pay their medical bills, virtually nobody denies that the human toll is real and significant.
These problems are the product, in part, a dysfunctional health insurance system that evolved haphazardly during the 20th Century. They also the product of a medical system as inefficient as it is costly. The United States pays more–far, far more–for health care than any other developed nation. But the care does not seem to be better overall, to say nothing of the fact that it is patently less available.
The goal of reform was really two-fold: In the short term, to make sure everybody can afford to pay for medical bills without financial distress; it the long term, to make the health care system as a whole more efficient, so that it no longer applied such a crushing financial burden on society. A single-payer system, like the ones in France or Taiwan, would have accomplished this. So would a scheme that turned health insurance into a regulated utility, as the Dutch and Swiss governments have done.
Political compromises, dating back to the earliest days of the 2008 presidential campaign, left the U.S. with a second-best–or, more accurately, a third- or fourth-best solution. It bolsters two existing insurance arrangements: Employer-sponsored coverage for workers in most companies, Medicaid for the very poor. It creates a new, regulated marketplace–insurance “exchanges”–for everybody else. Then, through a combination of tax changes and alterations to Medicare, it tries to reengineer medical care itself, wringing out administrative waste and focusing resources on the treatments, and care styles, that provide the most bang for the buck.
It’s easy to find the flaws–and to figure out who’s responsible for them. Doctors, hospitals, drug manufacturers, and device makers fought changes in the delivery of medical care that might affect their incomes; unions lobbied against tax reforms designed to discourage overly generous insurance; everyday Americans resisted changes to plans they already had. All of this blunted the Affordable Care Act’s efforts at cost control, which explains why, ten years from now, the best projections suggest we’ll have spent roughly as much on health care–as a government and as a country–as we would have if the law never passed.
At the same time, political conservatives fought to limit the bill’s expanse, demanding that the new outlays not exceed a $1 trillion, give or take. They had extra power, thanks to the filibuster, and were able to make the demand stick. As a result, the expansion of insurance coverage–via Medicaid and subsidies for private insurance–will not begin until 2014. Even then, somewhere around 20 million people, or 8 percent of the total population, will remain uninsured. And for some of the insured, the coverage will remain meager.
But the law’s shortcomings should not tarnish its many virtues. Eight percent uninsured means 92 percent insured, or around 95 of residents here legally. Or, to put it another way, more than 30 million additional people will have health insurance because of this law. The coverage, if not always as generous as it should be, will be enough to keep many if not most of the newly insured out of bankruptcy–and it will be available to almost everybody, regardless of pre-existing condition or insurance status.
The cost picture is also encouraging. The official projections suggest that, as of 2021, government spending (and, apparently, the country’s total spending) on health care will not be rising as fast as it is now. This is the critical distinction, because it’s the long-term burden of health care that threatens to bankrupt us. Critics doubt that officials will enforce planned changes to health care financing, but today’s lawmakers have no way to force action by their counterparts in the future. All they can do is put laws on the books–and that’s what they have done.
Are there better alternatives? Of course. But the loudest critics of the law, from the right, don’t have them. For all of their screaming, they have yet to put forward a credible plan that can do as much, let alone more, for less money. Their plans, stripped of misleading rhetoric, generally involve covering far fewer people, dramatically reducing the coverage that people have, or some combination of the two. Their dispute is not with the means Democrats have used to make health care affordable to all. It’s with the goal itself.
No, the way to improve the law is to build upon it–to bolster the insurance coverage, reach those Americans the law as written will not reach, and to strengthen the experiments in cost control that work. The best analysis of the law remains the one Senator Tom Harkin gave: The Affordable Care Act is not a mansion. It’s a starter home. But it’s got a solid foundation, a sturdy roof, and room for expansion.
A year from now, the presidential campaign will be well underway and the debate about the Affordable Care Act will likely be, if anything, more acrimonious than it is now. But perhaps after the election and, hopefully, after 2014, the country really will move on.
By: Jonathan Cohn, The New Republic, March 23, 2022
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 