The Conservative Plan: Don’t Get Sick

The Los Angeles Times is running a feature headlined “Conserva-care” in which four conservatives are asked what they would do to fix the nation’s health care crisis. Here is the short version.

First up is former Senator William “hide the cat!” Frist. Frist is an MD whose family fortune rests largely on the medical-industrial complex. I will come back to the Frist family business in a minute, but first let’s hear what Dr. Frist has to say.

The Frist plan for health care reform: Don’t get sick. Seriously. Live a more healthful lifestyle, and especially don’t get fat. It will lower the cost of everyone’s health care if we don’t need it so much.

Really, that’s it. That’s the entire plan.

Next is Mickey Edwards, former Republican congressman from Oklahoma. Edwards suggests a two-step approach:

Step one: Authorize creation of an alternative, non-government source of insurance — a “pool” that would allow the uninsured, self-insured, etc., to join in a private plan that would not be tied to any particular employer or association. This plan already has a great deal of bipartisan support and could easily be brought to life.

In other words, the public option without the “public.” I assume it would be left to the administration of the private insurance industry, which of course is eager to establish a less-expensive alternative that would complete with its own products. (/snark)

The second step is to regulate the insurance industry so that private companies no longer refuse to sell policies to people with pre-existing conditions. That’s a great idea! And it’s in the Obama plan already!

You’ve heard of David Frum. Frum, at least, is willing to admit the idea about selling insurance across state lines is a crock —

New Jersey health policies cost more in large part because New Jersey hospitals and doctors charge more. If I buy a cheaper Kentucky policy that reimburses my providers at Kentucky rates, leaving me to pay the balance, how much good does that do me? And if the Kentucky policy is made to pay New Jersey rates, there vanishes my low Kentucky price.

This has always seemed obvious to me, but I despaired of every seeing anyone on the Right understand this point. Anyway, Frum is thinking boldly. He wants to strip the states of their insurance regulatory policy to create one big national market instead of 50 state markets.

What we need instead is to assert federal regulatory authority over the whole marketplace and get the states out of healthcare altogether. Let the insurers do business as national entities; let the market contract to four or eight major insurers; and then let them do unto their suppliers as Wal-Mart does unto its suppliers: squeeze them.

Hmm, Wal-Mart. This reminds me of something.

You remember Rick Scott, the guy who organized Conservatives for Patients’ Rights and ran a bunch of inane ads against health care reform? Way back when Scott was the CEO of Columbia Hospital Corporation/Hospital Corporation of America (the latter being the old Frist family business, which Columbia purchased in 1994.

Anyway, while he was running Columbia/HCA, Scott preached loudly about the superiority of his efficient, for-profit business model over the sloppy practices of not-for-profit hospitals. His partner, Richard Rainwater (if that name sounds familiar — Rainwater had extensive business ties with George W. Bush) actually called Columbia/HCA “the Wal-Mart of healthcare.” Like Wal-Mart, he said, Columbia/HCA was a big chain that used volume buying and strict cost controls to provide services a low cost.

At the time, many not-for-profit administrators believed Columbia/HCA’s claims were hyperbole. In an article about Columbia/HCA by Joe Flower in Healthcare Forum Journal (March-April 1995), the senior vice-president of a prominent not-for-profit hospital group pointed out that healthcare managers all went to the same business schools, and that volume buying and cost controls were hardly revolutionary. “Price cuts from volume buying will not represent a sustainable competitive advantage for Columbia/HCA,” the senior vice-president predicted.

It turns out that Columbia/HCA’s real competitive advantage was not found in squeezing the suppliers, but in defrauding Medicare. Although he was never indicted, Scott was golden-parachuted out the door of Columbia/HCA in 1997, and the Frists swooped in and began running Columbia/HCA.

Anyway, however much money we might save from obtaining cheap medical equipment from China — slave labor and no quality control will lower costs — the Wal Mart approach already has been tried. Big hospital corporations and major medical centers already have been doing the volume buying thing for some time.

Well, Frum is a wuss, anyway. We finally get to Richard A. Viguerie, a true hairy-chested manly kind of conservative. He’s on Medicare, yes, but conservative nonetheless. Viguerie has a four-part approach.

One. Expect people to pay for much of their own health care out of health savings accounts. “When people spend their own money, they spend it more wisely,” Viguerie said. Patients need to have “skin in the game,” after which they may need to see a dermatologist.

The rightie idea is that Americans are getting too much health care. They demand health care they really don’t need because they aren’t the ones paying for it. If patients had to pay more of the costs themselves, they use better judgment about what health care they try to buy.

One problem I have with this theory is that in all those “socialist” (righties: I’m using the ironic sense) countries in which patients aren’t paying for their own health care, we’re not seeing costs go up as dramatically as in the U.S. Overuse of the system may be a problem in some countries, but other countries seem to be able to control it.

Also, in the real world, we’ve got these creatures called “doctors” who are the ones making the decisions about what tests, procedures, etc. their patients will receive, assuming the insurance companies approve it. And there are some aspects of some physicians’ practices that could use some reforming, Id say. I’m sure there are patients who do demand unnecessary MRIs because people are always getting MRI’d on House, but surely there are ways to control that beside expecting people to pay for their tests so they are not overused.

Also, in the real world, the health savings plan idea would work fairly well for upper-income people with no serious health problems, or for the fabulously wealthy. For everyone else, it would pretty much bite.

Two. Don’t allow government to control health care, Viguerie says. No one is calling for government to “control” health care.

Allow consumers to purchase insurance across state lines, which is a really bad idea.

Don’t discourage profits. I believe that’s from the Ferengi Rules of Acquisition.

Not much of a plan, but Viguerie isn’t done yet. Remember how uninsured patients are driving up everyone’s health care costs? Viguerie’s got the answer to that:

Obama claims that health insurance is a moral imperative. By law, hospitals can’t deny emergency treatment for patients who aren’t insured, leaving an unpaid care gap estimated at more than $50 billion annually, according to the American Enterprise Institute. Conservatives and independents at the tea parties, town halls and beyond believe it is a moral imperative to stop burdening the next generations with trillion-dollar deficits and to stop government’s stealing from the Medicare trust fund, which now has unfunded liabilities of $36.3 trillion, according to the Heritage Foundation.

OK, wait a minute — is he saying we should just not provide health care for people who can’t pay for it, period? Let ’em die in the streets? And this is somehow tied to saving Medicare, which is a single-payer health care system run by the government?

Well, yeah, that’s the end of Viguerie’s little essay. I guess that’s what he’s saying.

So, in a nutshell, the conservative plan is … don’t get sick.

22 thoughts on “The Conservative Plan: Don’t Get Sick

  1. The Atlantic had a column by David Goldhill a while back that pushed the pay out of pocket to control costs meme. It seemed clear when it first appeared that some republicans would be ideologically attracted.

    Baseline scenario did a good job showing what’s wrong with Goldhill’s ideas.

  2. RICK SCOTT: Whaddaya hear, Starbuck?

    BILL FRIST: Nothin’ but the rain, sir.

    RICK SCOTT: Well, grab your gun and hide the cat….

    Proper chain of command; just one more thing I’ve learned from Battlestar Galactica.

  3. I’m reminded of a snippet of movie dialogue–

    Bond: “What do you expect me to do?”
    Goldfinger: “Do, Mr. Bond? I expect you to die.”

  4. “So, in a nutshell, the conservative plan is … don’t get sick.”

    In reading this, I got totally sick… Now, I’m totally screwed!

  5. Obviously the real problem is that poor people need to die quietly. They are making entirely too much noise. It’s reached the point where the groaning is disturbing the champaigne & caviar parties for real Americans.

  6. Doug,
    The groaning is disturbing Bud Lite and mooseburger parties for “real” Americans.

    “… the groaning is disturbing the champaigne & caviar parties for” corporate, unreal Americans.

  7. Shorter translation: “If the peasants have no bread, then let them eat cake.”

    Erm . . . and how well did that work out for you, Marie?

  8. I work for an insurance company (property insurance – we hate health insurers as much as everyone else) and the folks I work for would love to have state regulation of insurance abolished in favor of federal regulation. Lots of states have passed rules requiring insurers to cover special stuff (like covering wind in hurricane zones) – once we have federal regulation, we’ll be able to write a bare minimum policy because that’s all that’ll be required. Forget having to lobby legislators in 50 states — it’ll be just the feds and they come cheap.

    Anything the insurance companies are that in favor of has to be good for regular folks too, right?

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  10. Words fail me. The moral bankruptcy of the entire capitalist system in the United States by the plutocrats still astounds me. The oligarchy rules. Need to find out how the Swiss got past their oligarchy to give care to everyone.

    Better yet, hire the Swiss to run the health industry, the banking industry, the investment community and the military/industrial complex on a percentage of savings basis.

  11. Boofus – funny, I too work for a property/casualty insurance co. Maybe because we write policies in just two Plains states (no hurricanes, and floods are extremely rare), my employers like state-by-state regulation just fine.

    But anyone who compares p/c insurance to health insurance is ignorant of the facts. Anyone who works for a p/c company and does so is… well, dishonest.

    Health insurance is subject to completely different market forces from p/c insurance. When Katrina hit, it directly affected a handful of states. When the swine flu hits, it hits everyone. Types of cancer may be industry-related, but cancer kills just as efficiently in all 50 states.

    The health insurers already are subject to federal regulation, because health practices, health records, and pharmaceuticals are subject to them. But at the same time, a national insurer like BC/BS currently breaks down into BC/BS of Iowa, or BC/BS of Nebraska, etc. From state to state people find themselves being screwed over to differing degrees, in different ways. Putting an end to the screwing-over must happen at the federal level. The health insurance industry has been fighting reform tooth and nail. Why is that, I wonder?

  12. If you haven’t read “The Political Mind” by George Lakoff you should. He explains everything you ever wanted to know about conservative and liberal thinking.

  13. The Frist plan for health care reform: Don’t get sick. Seriously. Live a more healthful lifestyle, and especially don’t get fat. It will lower the cost of everyone’s health care if we don’t need it so much.

    But the government can’t institute any incentives for people to live a more healthful lifestyle, because that’s Hitler/eugenics/fascism – just like they said when Obama actually proposed such things.

  14. These conservative twits are all wealthy and all suffer (as George W. Bush did) from an inability to imagine what it is like to be poor. This nonsense about “health savings accounts” presumes that poor people have a bunch of excess cash sitting around that they just need a tax-prefereced way to put to work. Guess what? They don’t.

    What galls me is that these rich snobs never utter a peep about the massive waste and fraud by military contractors and the Pentagon, but let a poor person get one Tylenol they didn’t pay for and they want to shut down the entire Dept. of Health and Human Services. While Blackwater and KBR rob us blind and slaughter thousands of innocent people. People like Viguerie and Frist have no moral compass.

  15. I saw an interview of Barney Frank on Rachel Maddow (a couple weeks ago), and he bascially said of conservatives “They Ain’t Got Nuthin”. A great deal of noise and fury, and stupid “plans” like you’ve outlined above.

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  17. Pete Hoekstra & Shaddegg didn’t have anything different to suggest earlier this month in the WSJ. They also support purchasing insurance across state lines if insurance companies could market to the consumer with commercials. They seem to think ads would drive down costs through competition. Even if that were true, I doubt the insurance companies would pass them on to the consumer. Being bombarded with the huge number of pharma ads on tv is irritating enough as it is.

  18. Joan — I’ll be the first to admit that I know nothing about the regulation of health insurance. I know about the regulation of property insurance and have projected, probably wrongly.

    I don’t know if health insurers are audited at the state or federal level. In P&C, we’re audited by the states, so replacing state regulation with federal would be quite a benefit. Fewer audits and not subject to each state’s quirks.

    I don’t know what sort of filing requirements the health companies have (in terms of rates, forms, manuals) — I know that it’s hard to write a policy that all fifty states will accept because each state has its own regulations (in P/C world) about (say) cancellation requirements, time available to file a claim, threats about the evils of filing fraudulent claims, and more.

    I want federal regulation of health companies. Actually, I want single payer, but I’ll settle for a public option and federal regulation. I just think that if the final bill were to end up doing away with state regulation without actually interfering with the companies ability to do whatever they want (Freshen your drink, Senator Baucus? And can I offer you this campaign contribution?), insurers would be absolutely tickled.

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  20. In my life before reincarnation as a goat keeper, I had a long, substantial professional relationship with the medical community in the Tampa Bay Area. There was a series of disturbing events involving Columbia/HCA, which, if memory serves, date prior to the acquisition by the Frist Family. They had the frequent desire to take over nice profitable hospitals. They made two attempts in Tampa. They both involved slimy tactics as I recall. Their chief strategy was to exploit any vulnerability, amplify it, drive the value of the hospital down and take over. In the early 90’s they had designs on two prominent hospitals in the area.

    Their wild appetite for acquisition was fueled by an uncommonly generous value to price ratio (6 to 1 if I remember correctly) which made acquiring new properties very profitable. So the SEC connection would be interesting as well.

    There is a story behind Columbia/HCA that highlights the failure of profit motivated healthcare. In all of the byzantine machinations, none contributed a whit to better healthcare or saving lives.

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