An attempt at a real “reset button” on health care

Posted on September 13, 2009


With the convening of Congress, the debate over health care reform has once again reared its ugly head. Despite promises of pushing a “reset button” on the back-and-forth rhetoric, the President’s speech served more as a further partisan rebuke to critics rather than a genuine moment of leadership and bipartisanship. That is his choice and prerogative, of course, but a genuine attempt at common understanding would, I think, be beneficial for the national debate. I certainly can’t speak for everyone on the right, only for myself, but this is how I see it.

First of all, there isn’t anyone in America that is satisfied with the status quo. Health care costs can no doubt be uncertain, as many times the cost of a health care visit isn’t always evident until after you get the bill. And whatever the number (I happen to believe it’s closer to 10 million than the 47 million often cited, which even the President pared down to 30 million to be truthful about covering illegals), there are people without health insurance who genuinely can’t afford it. Medicare will soon be bankrupt, and the growing number of retiring boomers does put a strain on the system. Reform of some sort is needed.

There are a few options not even on the table currently that should be discussed. Malpractice reform is one of these, and even the President conceded that “defensive medicine” may be a contributor to medical costs. Malpractice or tort reform does not mean malpractice abolishment – some sort of redress of gross incompetence must always be available. But in this overly litigious society, the threat of lawsuit hangs over every professional decision in every industry, including the health care industry. Tort reform isn’t a complete solution, but it ought to be a piece of the puzzle. That Obama would put in charge of the tort reform “test cases” an HHS Secretary who served for eight years as head of the Kansas Trial Lawyers Association represents a conflict of interest that belies an indifference in pursuing this path.

Next is the issue of interstate competition. The McCarran-Ferguson Act allows each state to regulate health plans within its borders, which results in different mandates in each state and ends up preventing insurance companies from operating competitively from one state to another. You end up with a situation like the one the President referenced in his speech, where in Alabama  Blue Cross and Blue Shield has 75% of the market share(not 90% as the President claimed). It seems like a no-brainer to relax this circumvention of interstate commerce and allow insurance companies to compete in all 50 states, which will result in lower prices (just as in the auto insurance industry) because more entities will be fighting for the dollar of the consumer. A repeal of McCarran-Ferguson might be an answer, but some sort of basic national regulation that waters down the individual state mandates could also be helpful.

This brings us to the public option, which the left assures us is the only viable way to drive down insurance costs. Never mind the fact that a full-blown government plan, in a perfect world, would be the option of last resort, where in this case it’s the first and only choice to be considered. A public option that, according to the advertising, would only exist alongside private insurers to serve as additional competition might serve a useful purpose if it was truly directed at competition, had a limited mandate, and would be allowed to fail if the private insurers proved themselves better.

The problem is that none of those statements, particularly the last, will be allowed to occur. A public option will be allowed to operate at a deficit indefinitely, with infusions of further taxpayer cash if the books look too bad. But the biggest issue is with the idea of competition and the proposition that a public option will only augment the private insurance industry and serves as no existential threat to its function.

The biggest refutation of that come from the public option proponents themselves. Rep. Barney Frank told liberal advocacy group Single Payer Action that a public option “was the best way to reach single payer,” and the President himself told AFL-CIO in 2003 that a single-payer system was what he believed in. Coupled with all the vehement anti-insurance rhetoric, it’s not hard to see that the desire isn’t to exist alongside private insurance, but to squeeze it out completely. It’s especially clear when you consider the high praise from the left for single payer systems like Canada and the UK. The public option isn’t supposed to be an “option,” but an means to an end, and that end is a single payer system.

A single payer system is the Holy Grail of the liberal health care reform movement. If that’s the ultimate ideal, and if single payer is such a superior system, then be loud and vocal and honest about it (and there are intellectually honest liberals who are). The President and Congress, however, knows they can’t be honest about their desire for a single payer system because it would taint the American people’s view of their assertions of a public option that exists innocently alongside private insurance companies. What results is a confusing mishmash of supposed disavowal of a single payer together with an endorsement of its forebear, the public option.

None of these arguments even scratch the surface of the potential cost of a public option in an environment that is seeing decreasing federal revenues and tougher economic conditions. The effects on the national debt and the federal deficit is routinely shrugged off as necessary and self-resolving in the long run. I have my doubts.

All of these views together is what generates anxiety and opposition to the current state of the health care reform legislation. To me, at least, we need to be clear about what the public option is, and what other options exist for lowering health care costs. None of what was stated above is an attack on those who desire health care reform by whatever means – it’s a rational statement of why there are major flaws in the framing of the health care debate.

A broad reset button would have been nice. This is only one man’s meager attempt at explaining the pitfalls of what we currently see. Instead of demonization, it would be nice to see discussion. We won’t see it, though – instead we’ll see blame and a possible nuclear option that will force a particular agenda through at the expense of national unity.

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