Comprehensively Do or Do Pass Health Reform; There is no Incrementally Trying

The previous Republican solutions to health care reform have been to change the definition of uninsured, talk about torte reform instead, talk about immigration instead, and produce torte reform bills that just happen to cover only 10% of the uninsured.

The latest Republican plan was announced at the Feb 25th bipartisan televised summit where everyone was carefully seated in a way that alternated boys and girls. Senator Lamar Alexander announced as folksily as he could that the Republicans favored an incremental approach because we "have proved we haven’t done comprehensive very well in Congress." The only thing missing was the "You betcha."

Congress hasn't done comprehensive well? By what standards? In health care alone, I recall the very comprehensive Medicare Provider Improvement Act of 2008 and Bush's 2003 Medicare Modernization Act. I recall some very comprehensive stimulus packages, credit card reform, and I don't even use my television set anymore. How incremental do Alexander's Republicans want to be? Do they want credit for showing up to work but don't want to strain themselves by being too comprehensive and turning on their computers? Can I tell my boss that I'll happily do an analysis of a problem but I won't actually solve the problem because it's hard to do comprehensive well?

The proposed incremental approach sounded good for about 15 seconds before I realized that it was just the latest version of the Republicans announcing that they are more concerned with their Facebook quizzes and figuring out which Lost character they would be than fixing health insurance.

Besides the abject disinterest that statement reflects, here's why incremental does not work in health insurance. There are 4 main markets or ways that people get insurance which are 1) through employers, 2) individually, 3) Medicare (you're at least 65), 4) Medicaid, (you make less than $14,000/year). Those markets are interrelated so if you make changes to one, the others are effected.

For example, if you do something to reduce the incentive for employers to offer health insurance, more people will enter the dysfunctional individual market with pre-existing conditions. The individual market would have to be changed at the same time to accommodate new entrants.

If insurance companies profitability in one line of business changes, they will have to raise prices in another line of business. For example, if Medicare cuts Medicare Advantage reimbursement by 2% like they did this year, insurance companies have to charge someone else, like employers or individuals, 2% more. And no, with profit margins of 3% and capitalistic and pillaging shareholders, insurance companies are still supposed to make money. Taking the loss is not really a viable alternative and cutting executive salaries would only cover a fraction of a percent.

Growing or reducing Medicaid can have an impact on individual and employer insurance. Bush opposed expanding the State Children's Health Insurance Program (SCHIP) because he felt that it would "crowd out" these private insurance markets. People would elect Medicaid instead of purchasing employer or individual insurance for their children. The "crowd out" effect is debatable but the bigger point is that even President Bush understands that health insurance markets are linked and incremental doesn't work! When President Bush needs to give you a lecture on how health insurance market, that should be an indication that your argument is starting to rank down there with the theory that polar bear farts are the primary cause of melting Arctic ice.

The two planks of the Republican health care reform also stink as bad as polar bear farts. They have held out 1) medical malpractice reform and 2) selling insurance across state lines as guaranteed ways to reduce the cost of health insurance without having to do all this complicated stuff. The CBO did an analysis of Senator Hatch's medical malpractice proposal and determined that it would save $54 billion over 10 years. That's about a 0.5% reduction in the growth of health care costs or what would be swallowed by medical inflation in about 2 months. In other words, this proposal would move health care costs from unsustainably unaffordable to unsustainably unaffordable. Notice any difference? Exactly.

I discussed the 2nd idea of selling insurance across state lines in this post where I called this idea Tweedledumber. At my place of work, I would be the one to analyze the decision to participate in this program and my recommendation would be a no, we do not want people in higher cost states buying my state's insurance plans because it will make my plans more expensive and less competitive.

With Republicans using their patented wide stance technique to piss away the chance to fix health insurance, it makes me yearn for a real conservative party. Since I spend more time reading the Economist than I do looking at my Grateful Dead bootlegs, I can now appreciate a good conservative fiscal policy. I'm still a big D Democrat due to my belief in spending to preserve a safety net and socially, I think that there should be national days of cross-dressing. However, I have stopped agreeing with everything Dennis Kucinich says. This Republican party does not provide a viable alternative and their dismissal of health care as a relevant issue is not something that I can easily forgive.

Obama's push to pass this bill through the reconciliation process regardless of the political fall out that he may face, both impresses me and makes me want to have a lighter ready the next time he goes out for a smoke. I now finally understand what he means about being a good one term president as opposed to a mediocre two term president. He would rather do the right thing with a comprehensive health care reform than just follow the polls incrementally.