Republicans Should Find an Approach to 'Universal Health Care' They Like

I’m not sure that I like this line of thinking, but I’m starting to think that it’s true, so I’ll put it out there and see what people make of it in debate.

It’s starting to look fairly certain that while a bill called “health care reform” will pass the congress and be signed some time before the 2010 elections (because the administration needs to sign something, even if it’s a fig leaf that does little and doesn’t go into effect until after 2012) what passes will not in any sense be a “comprehensive” health care reform package. Given the people who would be in charge of designing it if it made it through right now, I think that’s probably a pretty good thing.

However, conservatives would be foolish to rest on their laurels for the following reasons:

– Regardless of what we may think about subsidiarity and the importance of non governmental solutions, it has become fairly clear that the majority of the voting population is willing to consider it a major political issue if some people cannot get or cannot afford health care coverage.

– Just providing a tax credit to buy insurance (without requiring guaranteed issue and/or community rating in some form) will not satisfy this need in the minds of most voters, in part because:

– Many people are not very educated or diligent in seeking out all possible means of coverage that might be available to them (difficult and impossible become elided) and we as a society do not have the will (rightly or wrongly) to tell people: Sorry, you didn’t get yourself good coverage with the money you were given (or had) and so now you’re going to have to be crippled by medical bills.

– This doesn’t mean that something like ObamaCare or single payer health care needs to be adopted, but it does mean that some fairly simple system needs to be put in place that will ensure that everyone has some minimum level of coverage. Otherwise health care will remain a political live wire issue.

– If people with a reasonable understanding of markets and economics don’t put together a plan that meets these basic requirements while keeping in place incentives towards innovation and cost savings — eventually someone on the left will succeed in getting a single payer or otherwise economically disadvantageous program created. It’s only a matter of time.

I don’t really like all this, as I don’t accept that these things need to be solved at a national level. But given that it seems I’m outside the political center of gravity on this, I’m not sure that matters. The niche will eventually be filled, and it’s only a matter of who gets to pick the way it will be filled.

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  1. One thing’s for sure: We don’t want to follow in Canada’s footsteps!

    Escape to Montana: Canadians Seek a Private Option

    A bipartisan majority of the Senate Finance Committee defeated the health-care “public option” yesterday, though in our view Max Baucus’s bill will still reach the same destination, albeit more slowly. With that in mind, we offer as today’s commentary a cautionary tale from the land of the original public option, Canada…

    Whereas U.S. healthcare is predominantly a private system paid for by private insurers, things in Canada tend toward the other end of the spectrum: A universal, government-funded health system is only beginning to flirt with private-sector medicine.

    Hoping to capitalize on patients who might otherwise go to the U.S. for speedier care, a network of technically illegal private clinics and surgical centers has sprung up in British Columbia, echoing a trend in Quebec. In October, the courts will be asked to decide whether the budding system should be sanctioned. More than 70 private health providers in British Columbia now schedule simple surgeries and tests such as MRIs with waits as short as a week or two, compared with the months it takes for a public surgical suite to become available for nonessential operations.

    ‘What we have in Canada is access to a government, state-mandated wait list,’ said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. ‘You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list.'”

    In other words, while Congress debates whether to set U.S. medicine on the Canadian path, Canadians are desperately seeking their own private option. At least Ms. Woodkey had the safety valve of Montana and private American medicine. Once Congress passes a form of Medicare for all, with its inevitable government price controls and limits on care, Americans might not be so lucky.

    Let’s hope that by then Canada has expanded its own private option, so Americans will one day be able to visit Alberta for faster, better care. Unless Congress bars that too.

    SOURCE: http://online.wsj.com/article/SB10001424052748704471504574443253009607932.html

  2. I agree completely; this is one of those “like it or not” situations. There needs to be a better alternative to single payer that satisfies social justice and puts out the political fire — much like the graduated out-of-pocket/HSA/universal catastrophic insurance system that some have linked to/written about here.

  3. Regardless of what we may think about subsidiarity and the importance of non governmental solutions, it has become fairly clear that the majority of the voting population is willing to consider it a major political issue if some people cannot get or cannot afford health care coverage.

    I used to think this was true, but the recent debate has made me skeptical. Support for universal coverage is, well, universal, but it is also superficial. People are for it, but not if it means they’ll pay even a little bit more in taxes, or premiums, or might lose their current plan. That plus the fact that it’s hard to see how you have a “universal” plan without either a public option or some kind of mandate makes me think that adopting some sort of universal plan would be a bad move for Republicans, at least politically.

  4. I take that back. You could have some sort of voucher system, which would be universal. But I don’t really see that happening any time soon.

  5. I think that if Republicans want to win on this issue and the opportunity is ripe they need to decouple the two problems we are trying to address.

    1. UNINSURED – those that DO NOT have insurance.

    2. UNINSURABLE – those that cannot qualify for insurance.

    The uninsured don’t have insurance for many, many reasons. The only sub-class that may need true assistance is those who CANNOT AFFORD it becuase they are genuinely poor. $80,000 annual income doesn’t count as poor. I am referring to those who are truly poor becuase they have genuine problems of capacity, skill, ability or other such circumstances beyond their control. This is a small minority and I think we can take care of them personally. That failing, states can solve this problem themselves. Worst case, and I HATE this, the federal government can take care of it – it would cost much, much less for us to provide a tax-break, voucher or other form of paying for private insurance for these individuals who truly CANNOT afford medical insurance.

    The unisurable may need some type of program. It would be helpful if each state had a program to aggregate the risk of uninsured and use private insurance to purchase the coverage for the whole group similar to a large employer purchasing guarnateed issue policies for all employees. The total number of uninsurable is probably less than 5,000,000.

    Other than that promote a free market for innovation, competition, lower prices and access for all. Tort reform so actual negligence and crimainal activities are punished but don’t make it a profit center for attorneys.

    These simple points can be reduced to a 60 second commerical by a good marketing company and produced in a 5 page bill that anyone can digest.

  6. Well, if Republicans were as mean as their detractors appear to believe then a Make Democrats Pay For It All plan would be swell.

  7. One simple fix would be to make medical expenses and health insurance premiums above the line deductions (if not credits).

    In most communities, $80K does not go far for a family of four, with a kid in college and a less than 2000 sq ft home.

  8. The GOP has put out the Patient Choice Act which, despite the rather repulsive name (IMHO), has a fairly interesting set of credits and subsidies to help people go out and get their own coverage. And I agree it’s partly a matter of no one paying any attention to their proposals.

    However, it strikes me that GOP proposals have to an extent been too much aimed at the sort of middle to upper middle class professionals who make up the more active part of the base. The problem, to my mind, is that for a lot of people that wide open a choice doesn’t seem like a solution.

    My fear is that the GOP won’t be seen as offering a solution by the general population unless there’s a fairly simple default option (such as: If you don’t have insurance through your employer you do X and get coverage) even if there are then a fair number of flexible options that one _can_ take advantage of if one has the interest.

    Kind of like how a lot of people actually aren’t comfortable with the idea of retirement accounts instead of standard social security.

  9. Darwin,

    I agree that simple and clear is preferable. But then the Democrat’s plan isn’t really a model of clarity, is it?

  10. Not that I think the Republicans shouldn’t have a concrete counter-proposal, but I can’t help but wonder why they should bother. Honestly, why go through the motions when you know nothing you offer has a chance in hell of being adopted?

    It could be argued that the GOP should take the time to present a more viable option for public consumption. Perhaps. But again, how much does the public really care? If they are upset with or simply don’t like the Democrats’ proposal, then does it really matter politically whether or not the GOP offers a substantive health care plan?

    I repeat, these are mainly political points. I do think that minority parties should formulate concrete ideas and not simply say no to everything.

  11. Not that I think the Republicans shouldn’t have a concrete counter-proposal, but I can’t help but wonder why they should bother.

    One of the reasons why I happen to disagree with DarwinCatholic insofar as Republicans needing to present an alternative proposal is because of the fact that it is the Democrat-ic administration that is proposing a change in the status quo and, therefore, I would think, the burden falls on them.

    While the status quo itself might seem unacceptable, it doesn’t help at all should the change, such as those that the Democrats at the Hill actually advocate, would result in even worse circumstances, as clearly the case has been for our Canadian neighbors as far as a similarly conceived/implemented national healthcare is concerned.

    It may very well be the case that the status quo is far more preferable than any of the proposals currently in play.

    It would be better for folks to first take the time seriously required (be it months or even years) to formulate something that would be far more superior than those we have now as opposed to having any such plan, regardless of the consequences, put in place simply for the sake of expediency as well as appeasing certain parties.

  12. I don’t think there’s any point in putting another proposal forward now, actually. More like the GOP should plan on having a fairly clear proposal to run on in 2010 with the claim, “Democrats said they were going to give us health care reform, but instead they gave us an incredibly expensive boondogle that hardly helps anyone, makes things more complicated and doesn’t even go into effect until 2013. We have a simple, cost effective plan now.”

    Or, indeed, some presidential candidate could make that the theme in 2012, the interest still seemed to be there.

    I don’t think the GOP has to push something now, because it would vanish down a political black hole. It’s more that I think if the GOP is successful in staving off the Dems this time, they need to bring a very solid proposal to the table next time they do end up with a majority (or are trying to get a majority) and get something real done. Otherwise, we’ll end up running this same farce again in 10-12 years just as we did in 93 and 09.

  13. Agreed. The GOP can actually out-healthcare the Dems by proposing a market-driven alternative of their own. They have tort reform on their side. Most Republicans already support guaranteed issue. You don’t need a mandate during this round of reform because guaranteed issue will eventually lead to a mandate.

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