by Linda Beale
Health Care: The House’s Vote to Repeal
crossposted with Ataxingmatter
Well, they’ve done it. The House Republican majority pressed ahead with their repeal of health care reform, putting us (if their bill were to become law) right back in the mess of spiralling health care costs, tens of millions of uninsured Americans, and no handle at all on how to deal with it. The vote was 245-189, with three purported Democrats joining the entire Republican House membership in voting for Big INsurance and against ordinary Americans. See Herszenhorn, House Votes to Repeal Obama Health Care Law, New York Times, Jan. 19, 2011. For background, see this “backgrounders” (available on BNA) from the House Energy and Commerce Committee chaired by Republican Fred Upton (noting the priority for repealing “Obamacare”).
The health reform passed last year was far from perfect–partly because it was based on a Republican-generated model for health reform that relied too much on private sector self-policing, rather than setting up a single payer system or at least a public medicare-like option to compete with the private system we have now. Our medical system without reform combines the worst of all possible worlds–very high cost (much more costly than those of our peers like Canada) and mediocre service (for all but the wealthiest oligarchic members of our society, who are empowered by their wealth and able to get just about anything they want). So the Republicans have taken a less-than-perfect bill that at least provided medical care for 30 million uninsured Americans with a mandate for coverage that made that insurance affordable and at least addressed some of the painful examples of insurance company power to put their profits above reasonable medical coverage of their customers by eliminating the pre-existing condition provision (which could impact insurance coverage for about half of all Americans, according to a recent study discussed in the Times) and they have proposed simply saying no and putting us back at square one.
If their proposal had offered a better way to achieve the much needed objective of providing universal insurance (or at least coverage for the 30 million aided by the reform legislation), then that might be something worth looking at. But they haven’t bothered to do that. And regretably, the “free market” alternatives that they pushed during the discussion of the existing bill don’t promise much. We’ve had a free market in insurance for decades. That’s why we have a problem. INsurance is too lightly regulated, with companies able to pit state against state and get by with almost no regulation. Insurers put profits first, and have become notorious for denying coverage for technical faults that shouldn’t result in denial of coverage or just delaying payments for so long that insureds end up suffering significant economic damage that the insurance plan was supposed to prevent. They write policies intended to provide skimpy coverage for those who aren’t likely to need it, and shun people who are likely to need medical expense assistance since they are the ones that keep their profits from soaring even higher.
The Republicans’ primary idea of “reform”?–allowing sales of insurance across state lines and enacting tort reform. See, e.g., tweets from Rep. Shimkus, including this one (Jan. 19, 2011) re “we will allow sale of insurance across state lines, allow sm biz to join together to purchase plans, enact meaningful tort reform.”
Let’s consider tort reform. What David Hylton and others have shown is that there is really no need for tort reform. Awards have actually not been skyrocketing, and the tort process works fairly well to provide a remedy that would otherwise be missing for medical malpractice–such as when the wrong arm or leg gets operated on or the wrong organ implanted, etc. Hospitals have adopted better oversight because of tort cases that challenge them to greater competency. Tort reform as preached by most Republicans amounts to a claim that any system that gives some measure of remedy and justice to ordinary victims is bad, because it cuts into the profits of insurers. In other words, tort reform is a euphemism for politicians in the pockets of Big Medicine.
What about the idea of competing across state lines? That’s the worst nonsolution imaginable–it removes the little bit of regulatory power that individual states have, lets companies troll for healthy customers by aiming their policies towards that clientele while rejecting those that they might have to pay for; and invites insurance companies to engage in the kind of “what favor will you do me” arbitrage that already has states sacrificing good policies to entice bad companies to “use” their subsidies. Without strong federal regulation, it would be a health care disaster. The idea is based on a ideological view of economics 101 that says that increasing competition will always improve the market place. But that “law” of supply and demand doesn’t really work the way that economics 101 suggests in the first place, and it is even less of a reliable rule when we are talking about something like health care.
Let’s play the hypothetical game we love so well in law schools. Imagine one state that requires hospitals and clinics to satisfy various requirements to operate and another that doesn’t. Clinics that don’t have to satisfy requirements operate more cheaply. And insurers that insure only patients who use those clinics can pay out less. So that probably means you can get cheap insurance if you buy from a company that requires you to use those cheaper, unlicensed clinics. Interested? I doubt it.
These and many other issues would arise in a market where insurance companies could pit state against state to pick the regulatory regime that pleases them. See, e.g., Ezra Klein, Selling Insurance across state lines: a terrible, no good, very bad health-care idea, Washinstong Post, Feb. 17, 2010 (noting what happened with the “freeing” of credit card banks do operate cross-border and concluding that such moves would not insure more Americans or save money but make insurance more expensive for the sick and maybe cheaper for the healthy–“a great proposal if you don’t ever plan to be sick and if you don’t mind finding out that your insurer doesn’t cover your illness”); Why Buying Health Insurance Across State Lines Minght Not be a Good Idea; Allowing health insurers to sell across state lines is a BAD idea on Democratic Underground (suggesting that our experience in opening up the credit card interest is a good warning, since credit card banks moved to the states that allowed the highest interest rates). So insurance across state lines is likely to be a race to the bottom in health care coverage, with a race to the top in premium pricing for anyone who really may have a serious illness that needs to be covered. The result would likely be cheap coverage for healthy individuals that mostly don’t need it and out-of-sight expensive coverage (but still probably unsatisfactory) for those who do.
In other words, the primary plan that the Republicans have offered so far as their panacea for “reforming” health care is one that is of great benefit to Big Insurance (allowing it to select the regulations it wants to abide with and make profits from healthy people while disregarding those who may really need insurance) and dastardly for all of us who will, inevitably, get sick or have an accident and need medical care. Only a universal, national plan of some kind will satisfactorily address spiraling medical costs and growing medical needs.
Further, the Republicans have been utter hypocrites in the way they have dealt with this. They say they oppose the bill at least in part because it will be costly. Let’s evaluate that. FactCheck.org shows that their claim that it will “add over $700 billion in red ink over the next decade” is simply “bogus.” A Budget-Busting Law?, FactCheck.org, Jan. 19, 2011 (and the Democrats’ claims are also exaggerated). The Republicans conjure up $115 billion of administrative costs over the next ten years, but the CBO–our best arbiter on these issues–says those numbers are way too high and that the cost will be a modest 10-20 billion. The Republicans claim that estimates that show costsavings are based on doublecounting, but the CBO is “simply not doing that”, according to FactCheck. The Republicans have added in monies that they themselves want to spend to increase their claims about the law’s cost (as though that is bad)–even though they support that separate expenditure for the “medicare fix” for doctor payments and it is not even a part of the health reform law! Id.
And they aren’t really serious about ensuring that we finally reform our health system to begin to address the costs. If they don’t achieve repeal by the honest way, then they intend to exercise minority veto of the majority’s legislative preferences through trying to choke off money –both appropriations and the mandate that most employers provide a health insurance benefit for their workers. As John Lewis noted ” It is unbelievable that with so many people out of work and millions of people uninsured, the first act of this new Congress is to take health care away from people who just got coverage.” House Votes to Repeal Obama Health Care Law, New York Times.
Further, they are being untrue to the basic principles of individual responsibility that they claim to support. The individual mandate is a mechanism to ensure that people can’t choose not to buy insurance, using their funds for other needs, and then freeload off the system at the expense of all of the rest of us. It is the only such mechanism that the Congress has been able to agree on in all of these post-war years when our peers in the developed world long ago found a way to achieve universal coverage at a decent cost. Yet instead of decrying freeloading, the Republicans have decried the mandate as government intrusion. That makes a good soundbite for the Fox-Hannity crowd, but it isn’t what’s going on. And they aren’t offering any other solution to the problem.
You want to know what I think, really? I am in one of these very pessimistic moods. The Democrats weren’t able to use their majority wisely but wasted it trying to achieve “bipartisanship” rather than honing their message about how government can and does serve the people to help people separate the huge amount of pseudo-news chaff from the hearty grain of information that we need to have a sustainable democracy. Now we’ve got the Republican minority calling the tunes in Congress–or at least making it even harder to do anything decent . And as long as the Senate sticks to the stupid tradition of allowing a minority to veto any decision it doesn’t like through the filibuster rule, that will continue.
Because the reality is that the Republicans don’t want to address the real problems that face this country. They just want to keep mouthing the same old shibboleths of “free market” and “competition” and “property rights” that they have used for so long to further the interests of the monied upper class, no matter what the result for the US economy and the public weal. They want to oppose progressive policies (even ones that were proposed first by Republicans). And they don’t give a damn about whether the 50 million uninsured Americans can get decent health care. They don’t even give a damn about addressing long-term fiscal needs of the country. They just want to fire workers (especially ones that are unionized) so that bosses and owners can take home even more of the profits, and let Business go on as usual.