Sort of Playing the Game: Republican's Health Care Proposal

Three months ago, the Republican released their health care reform principles which pretty much amounted to disagreeing with the Democrats, a lack of understanding that government is pretty involved in the health care system right now, and how they also liked ice cream on hot summer days. I've realized more and more that Republicans truly don't think that anything is really wrong with the health care system. I've heard phrases like:

• Polls point out that 75%-85% of people rate their health insurance as good or excellent. Therefore, only 15%-25% of people are unhappy and this is not a big problem even though people will not start businesses in order to keep their employer health insurance.
  
• Everyone access to health care through the emergency room so this is really a health insurance issue. There's a reason we call it a health care system. Using the Emergency Rooms is not a very efficient approach and is kind of letting someone else worry about the problem.
• Their plan is "patient" focused. I would like health care to kick in before we become patients or sick. It kind of nicely symbolizes how they don't think about health care until it's really a problem

Their latest proposal which came three month late at least had numbers and at least they're paying attention. Here's my the good, the bad, and the ugly take on it.

The Good:

• The proposal spreads the employer tax break to those who purchase individual insurance. Rather than eliminate the tax break for employers who buy insurance, they widen the tax break. It does level the benefit playing field and is a fair idea to consider.
• There is also an idea for employers to take that same tax breaked or tax broken health insurance benefits and give it to employees as cash. Employees could decide if they want to buy health insurance or spend it on crystals and herbs. This could provide a real opportunity for health care providers and plans who can explain their value proposition well.

The Bad:

• While the plan will prohibit insurance carriers from denying individuals based on pre-existing conditions, the individual insurance market still has its dysfunctions. Given this proposal is making employer-based insurance less attractive, it needs to ensure a functional individual market.
• States are given grants to improve high risk pools for those cannot purchase private insurance. This further underscores that the individual market will not be expected to provide coverage for all but there will need to be a safety net that is not planned to be sufficiently funded.

The Ugly:

• It weakens the Council for Comparative Effectiveness Research by requiring approval from medical societies. This Council was part of Obama's first stimulus project and is inteded to promote evidence-based care and ideally allow cost-effectiveness to be a criteria for evaluating treatments. Why would the Republicans want to weaken this clinician-led Council? There is no apparent reason to me other than to be cynical and assume that it's helping pharmaceutical and medical device companies who are the most vocal opponents of comparative effectiveness research.
• The proposal does focus on medical malpractice reform by limiting jury awards which isn't a bad idea. However, it proposes setting up a new court system to evaluate medical cases. What's wrong with the exiting court system? It befuddles me why we would create a new judicial body unless it's so everyone can get free drugs during the trial.
• Some of the savings will come from reducing Disproportionate Share or DSH payments to hospitals that see a high number of uninsured. I hope that this cut is tied to a reduction in people without insurance rather than a theory that a hospitals should not see any benefits for seeing more patients without insurance. However, if a proposal was really serious about reducing the uninsured rate, why not assume that this payment will not be necessary?

I prefer to be political in my comments on other's posts rather than bring politics into this blog. I'm not that interested in debating for the sake of debating since we won't change each other's minds. The Republican's lack of effort on health care reform arouses my blogging ire because well, claiming they're ignorant, out of touch with reality, or nasty isn't really a better way of saying it. Actually, I'll go Sonia Sotomayer on them and accuse Republicans of a lack of empathy.

The bigger issue for me is that the goals of their proposal is tort reform and tax breaks as opposed to any vision of what a future health care system would look like. It's clear that they don't feel a need to reduce the uninsured rate, have no provisions to improve quality of care, or help make better decisions about how to use health care dollars. I can almost hear the yawn from the proposal writers as they write it.