Republican Health Care — Oxymoron?

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Obama Administration

Because they whine that no one takes them seriously, I’ve been trying to learn more about what Republicans really, truly propose to do about health care beyond don’t get sick.

Here’s the official Republican explanation of the official Republican health care reform plan, as explained on GOP.gov, the official congressional Republican website. You can find more details on Congressman Roy Blunt’s site. Here’s the outline — the Republican plan —

  • Would allow people who purchase insurance on their own to take an “above the line” deduction equal to the cost of an individual’s or family’s insurance premiums.

I assume this is without an income limit, as if your medical expenses are high enough and/or you are poor enough you can do that already. Notice it’s not helping poor folks buy insurance.

  • “Provides immediate substantial financial assistance, through new refundable and advanceable tax credits, to low- and modest-income Americans.”

And this would work, how? I looked at H.R. 3400, the Empowering Patients First Act, which I believe is the GOP’s most recent proposal. Section 101 (beginning on page 4) is on tax credits. I can’t decipher it. If any of you want to give it a shot, be my guest.

In any event, is this a plan to set up a government bureaucracy to which people would apply for credits or refunds? And this is supposed to save the taxpayers’ money?

  • “Recognizes that many Americans who have not yet hit retirement age but may be changing jobs or have lost a job often face higher health care costs. To help those aged 55 to 64, the plan increases support for pre- and early-retirees with low- and modest-incomes.”

What does that mean, “increases support”? I dimly remember there was talk of this regarding a McCain proposal, but I don’t remember and cannot find details. If you can offer any clues, let me know.

  • “The plan allows states, small businesses, associations, and other organizations to band together and offer health insurance at lower costs.”

That’s fine, but by itself it’s like giving people a pile of rocks and telling them to fill the ocean.

  • Implements comprehensive medical liability reform that will reduce costly, unnecessary defensive medicine practiced by doctors trying to protect themselves from overzealous trial lawyers.

Enough of this. I give you Mitchell Schnurman, Dallas-Fort Worth Star-Telegram, on the state of “defensive medicine in Texas six years after their last big “tort reform” act that was supposed to solve their health-care crisis:

Roughly half as many malpractice suits are being filed in Texas these days. Liability premiums, which had doubled before reform, have declined more than 30 percent. …

Healthcare spending has grown faster in Texas than the rest of the country. Patients are paying more for health insurance and medical bills. Doctors do more tests and scans, an indication that so-called defensive medicine hasn’t declined here.

There also hasn’t been more coverage for the uninsured, a top priority in the Obama push. In Texas, 1 in 4 residents has no health coverage, the highest percentage in the nation and well above the national norm.

See, doctors will self-report that they order X amount of texts and procedures because they are afraid of litigation. Much of the estimates about the astronomical costs of “defensive medicine” are based on those self-reports. But in the real world, in every state that has drastically reduced the number of malpractice suits through tort “reform,” we see no reduction in either costs or in the amount of tests or procedures ordered. Relieving them of much of the jeopardy of litigation does not change physicians’ test- or procedure-ordering habits, in other words.

  • Provides Medicare and Medicaid with additional authority and resources to stop waste, fraud, and abuse that costs taxpayers billions of dollars every year.

Everybody, including President Obama, wants to wring savings our of Medicare and Medicaid. How much real waste, fraud, etc. exist in this programs, and how realistic it is to get “billions” of savings out of them, I cannot say, but I think I’ll put that investigation off for another post.

  • Creates incentives to save now for future and long-term health care needs by improving health savings accounts and flexible spending arrangements as well as creating new tax benefits to offset the cost of long-term care premiums.

In other words, instead of reforming the current system, we’ll use tax credits to support the current system. And health savings accounts are a joke for anyone except the already wealthy.

  • “Gives financial help to caregivers who provide in-home care for a loved one.”

That’s it. According to Rep. Blunt, that’s the plan.

I want to go back to H.R. 3400. I don’t have time to wade through the whole thing line by line, but this one part jumped out at me.

SEC. 201. REQUIRING OPERATION OF HIGH-RISK POOL OR OTHER MECHANISM AS CONDITION FOR AVAILABILITY OF TAX CREDIT.

No credit shall be allowed under section 36B of the Internal Revenue Code of 1986 (relating to health insurance costs of low-income individuals) to the residents of any State unless such State meets the following requirements:

(1) The State must implement a high-risk pool or a reinsurance pool or other risk-adjustment mechanism (as defined in section 211).

(2) Assessments levied by the State for purposes of funding such a pool or mechanism must only be used for funding and administering such pool or mechanism.

(3) Such pool or mechanism must incorporate the application of such tax credit into such pool or mechanism.

Help me out, here — what are the Republicans up to with this? It doesn’t sound good.

I realize that the purpose of HR 3400 was to have a stack of paper to wave at President Obama and call a “Republican health care plan.” I doubt even the Republicans take it seriously as a legislative proposal. But I do think it’s important to underscore the fact that the Republicans, in effect, have no plan.

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12 Comments

11 Comments

  1. c u n d gulag  •  Sep 21, 2009 @2:36 pm

    In the Republican world, the solution to everything is tax cuts.
    – The economy favors the rich – cut taxes on the rich and pray that some
    money “trickles down.”
    – The economy needs a pick-me-up – cut taxes.
    – The economy is tanking – cut taxes.
    – People are unemployed, how do you help provide jobs – cut taxes.
    – People can’t save enough money – cut taxes.
    – Start two wars, and how do you fund them – cut taxes.
    – Maintain two occupations – cut taxes.
    – People can’t afford health care – cut taxes.

    You know, a “Magic 8 Ball” has more answers. So does a poorly designed childrens toy, where you pull the string to hear it speak.
    The elephant is an outdated representation for the Republican Party in cartoons. May I suggest to cartoonists that they now draw a one-trick pony instead.

  2. justme  •  Sep 21, 2009 @3:38 pm

    Well here I am, the voice of the working mega poor ready to weigh in. Sigh…So let me see if I have the jest of the rights plan to solve the health care crisis for folks like me..first don’t get sick,, but if I do then they want the government to send me a check to pay for my health insurance? All of it? Do I understand this right? They want the federal government to fund my health insurance? Welfare for 40 million is what the right proposes? Come on! Really?Now do I get to shop for my own plan/company? Or does the government somehow get to decide what kind of coverage they will pay for? Cause I mean I want the same insurance senator grassley has that has made him forget about how the working poor live..and if it is good enough to be given to our public servants it is damn well good enough for me too.Can I go and pick the most expensive plan I can find and request my big ass check from the government along with some cheese?
    If they are offering tax payer dollars to be redistributed to me to pay for health insurance isn’t that socialism? Isn’t that the take from the rich and give to the poor idea they hate so much? And if they are offering free money to me to pay for coverage how in the hell do they intend to pay for it? And why would anyone buy insurance anymore if they could get the government to pay for it? So won’t everyone want their government check? It seems to me that trying to insure 40 million or so is a drop in the bucket compared to the people who will be requesting their insurance check under the can of worms they want to open.

    And a high risk pool??? Can you say death panels?????Who gets to decide who is high risk? Is this like the pre- existing condition thing? Been knocked up? You could go to a high risk pool!!!!Insurance companies are gonna take FULL advantage of that. High risk premiums are much higher than regular ones so I foresee everything including a hangnail to be considered high risk by insurance companies. Got corns on your feet? Pre-existing condition which makes you high risk, therefore the government has to send a bigger check to cover you.CHACHING! 99% of people have seen a doctor for something that is a pre-existing condition that could allow insurance companies to determine anyone high risk.The insurance industry must be giddy!
    Ok you sick people.. you will not be allowed to burden the insurance companies covering the well with your illness! Got that? We will throw money at some insurance company to claim you are insured(although they will cover nothing) until you die.
    Gosh the GOP is smart… why is it they lost elections again?

  3. uncledad  •  Sep 21, 2009 @3:43 pm

    “Implements comprehensive medical liability reform that will reduce costly, unnecessary defensive medicine practiced by doctors trying to protect themselves from overzealous trial lawyers”

    Why does every conservative proposal for dam near anything involve taking away ordinary people’s right to sue corporate America for wrong doing? No need to answer.

  4. joanr16  •  Sep 21, 2009 @6:30 pm

    costly, unnecessary defensive medicine

    I want this phrase defined for me by its authors. I mean, wtf? It’s “Jabberwocky”– hysteria over a nonexistent creature. I’ll get the smelling salts so we can bring those eminent Victorians of the GOP around… so’s we can slap ’em.

  5. joanr16  •  Sep 21, 2009 @6:42 pm

    a high-risk pool or a reinsurance pool or other risk-adjustment mechanism

    I think justme is right about what becomes, in effect, real “death panels;” for me, the key phrase is “risk-adjustment mechanism.” This is how I read it: Section 201 (or “District 9,” as it may come to be known) requires states to hedge its bets against its unhealthiest citizens, or it will lose tax credits that have been in place for 23 years.

    Yeah, that’s progress.

  6. joanr16  •  Sep 21, 2009 @7:01 pm

    Definitions of acceptable pools, from the subsequent section (211):

    [(A) EXISTING HIGH-RISK POOLS that] only cover high risk populations and individuals (and their spouse and dependents) receiving a health care tax credit under section 35 of the Internal Revenue Code of 1986 for a limited period of time as determined by the Secretary [of HHS, I believe] or under section 2741 of Public Health Service Act.
    (B) NEW POOLS.—A qualifying high-risk pool created on or after such date that only covers populations and individuals described in subparagraph (A) if the pool—
    (i) offers at least the option of one or more high deductible plan options, in combination with a contribution into a health savings account;

    In other words, same old crap; new wrapper.

  7. c u n d gulag  •  Sep 21, 2009 @8:43 pm

    Joan,
    “costly, unnecessary defensive medicine.”
    They’re all costly and unnecessary defensive medicine mechanisms unitl they come to you or a loved one. Then, if you can pay for it, it’s only costly to you, and the defense is worth it. If you can pay for it…

  8. Sam Simple  •  Sep 21, 2009 @10:12 pm

    The language in the legislation basically means a family of four would be eligible for up to a $5,000 credit, provided they were below 200% of the poverty level, which is $42,400 in the contiguous U.S. However, this is a “non-refundable” credit, meaning you can only claim it to the extent you have taxable income. In other words, it is highly improbable you could ever claim the refund because at such a low income level, you wouldn’t owe enough tax to offset the cost of the out-of-pocket costs of your health insurance. In other words, good fucking luck claiming it!

    As far as the tort reform, Republicans are obsessed with putting the hurt on trial lawyers, since they tend to vote Democratic. They get a big boner if they think they can hurt a Democrat, even though tort claims represent less than 10% of the cost of health care. What a bunch of fucking assholes!

  9. joanr16  •  Sep 22, 2009 @8:52 am

    The language in the legislation basically means a family of four would be eligible for up to a $5,000 credit, provided they were below 200% of the poverty level….

    Hmmm, that sounds oddly famil– wait, that’s essentially what John McCain proposed during the presidential campaign! Until it was pointed out that a family of four can’t get health insurance for less than $12K or $13K a year.

    And at 200% below the poverty level, the family of four scraping up $7-8K (at least) falls under the category of “and then a miracle occurs.” So would $5K buy four plane tickets to Lourdes?

  10. Rick Massimo  •  Sep 22, 2009 @12:18 pm

    ■“The plan allows states, small businesses, associations, and other organizations to band together and offer health insurance at lower costs.”

    Awesome! I’ve got an even better idea – let’s have THE WHOLE COUNTRY band together! Then health insurance will cost even less!

    Oh, right – that’s what Hitler wanted. Or Stalin. One of those completely interchangeable guys.

  11. maha  •  Sep 22, 2009 @2:51 pm

    Rick — some on the Right do want a big national pool, but they want the private health insurance industry to run it.

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