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 â€œabove the lineâ€ deduction equal to the cost of an individualâ€™s or familyâ€™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 hasnâ€™t declined here.
There also hasnâ€™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.