Thursday, May 28, 2009

Republicans Making Moves On Health Care Reform

TW: We appear to be on our way to some form of health care reform. The fiscal realities driven by demographics are becoming increasingly dire, a consensus that change is required is no longer very controversial. How to do so is of course debated but interestingly the Republicans and Dems are not that far apart. The recent proposal by a prominent group of Republican congressmen is a step in the right direction. Although their proposal much like the Dem's skirts the fundamental questions of cost containment.

They propose removing the tax exempt status of employer funded health benefits (not likely to happen) and uses that money to subsidize individual plans. Their plan would leave more folks uninsured than the Dem's plan (no mandated insurance) and seeks to use some privatization principles. We shall see...


From Karen Tumulty at Time:
"The last time this country undertook a serious debate over health-care reform, back when Hillary Clinton put together her proposal in 1993, the Republican strategy could have been summed up in three words: Just say no. This time around, however, the clamor for fundamental change of a system that covers too few and costs too much has grown to the point where the minority party knows that simple obstructionism is a dangerous route to take.


"The status quo is no longer acceptable," political strategist Frank Luntz wrote in a confidential memo to congressional Republicans earlier this month. "The overwhelming majority of Americans believe significant reform is needed — and they see Republicans (and the insurance companies) as the roadblock. If the dynamic becomes 'President Obama and congressional Democrats are on the side of reform and Republicans are against it' — which is exactly what Obama has already started to promote — the public will side with the Democrats and you will lose both the communication and the policy."


What kind of health-care reform would Republicans like to see? Four conservative GOP lawmakers — Senators Tom Coburn of Oklahoma and Richard Burr of North Carolina, along with Congressmen Paul Ryan of Wisconsin and Devin Nunes of California — introduced a proposal on May 19 that looks a lot like the one John McCain advanced during his presidential campaign as well as an idea George W. Bush advanced as President.

But it also includes the kind of rhetoric more generally associated with the Democrats. A 15-page summary of the bill begins: "It is time to publicly admit that the health-care system in America is broken. Costs are rising at an unacceptable rate — more than doubling over the last 10 years, which is nearly four times the rate of wage growth. Too many patients feel trapped by health-care decisions dictated by HMOs. Too many doctors are torn between practicing medicine and practicing insurance. And 47 million Americans worry what will happen to them or their children if they get sick."

The GOP plan would make the health benefits that companies provide their workers count as taxable income, and then use that money to provide tax credits with which individuals could purchase their own health coverage...it would provide new incentives for insurers to offer coverage to people who now have trouble buying it because they have pre-existing health conditions. It also puts more emphasis on preventive care and sets up "state exchanges" — similar to the one now operating in Massachusetts — in which individuals and families could comparison-shop for insurance plans.

However, that Republican bill does not purport to assure coverage to all — or even most — of the 47 million or so Americans who now lack it. It does not, for instance, impose a requirement that employers provide coverage to their workers or that individuals who do not get health benefits at work buy them on their own. The tax credits that it provides — $2,300 for individuals and $5,700 for families — fall well short of the average annual cost of a health policy, which is between $10,000 and $12,000 per family, says Robert Blendon, professor at Harvard.

Coburn, a practicing physician, disputes Blendon's analysis of his bill. "In the vast majority of cases, our credit will more than cover an employee's share of a health plan's cost, which is about a third of a plan's total cost, or $4,000," Coburn says...

...one thing seems clear: Republicans have figured out that, this time, the debate over health-care reform is not one they are going to win simply by saying no."

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