Wednesday, May 30, 2007

The Other GOP Presidential Pickle

I haven't paid much attention to the health care plans proposed by John Edwards, Bill Richardson, Barack Obama, Hillary Clinton, or any of the other Dem presidential contenders. While I think health care is a national issue, it's my feeling that fundamental health care reform has the best chance of passing at the state level.

But that doesn't change the fact that health care is one of the top domestic priorities in this country. And I'm not alone on that one. Just about every poll to broach the subject shows that Americans agree on this point, and the agreement often spans the political spectrum.

For instance, a Pew poll last summer found that 89 percent of Dems believe health care is a "very important" issue, while 79 percent of independents and 69 percent of Republicans feel that same way.

So it's certainly not surprising that the Dem candidates have all spoken out on the issue. But what's a bit surprising is the silence on the issue from the right.

Health care blogger Bob Laszewski recently took a peek at the web pages for the three top GOP contenders -- Rudy Giuliani, John McCain, and Mitt Romney -- to find out their thoughts on the issue of health care.

Giuliani and McCain both offer up comments on about ten issues, but none of them even touch on health care. Romney does list health care as the tenth out of eleven issues he discusses, but his thoughts are limited to a couple of statements that center on the idea of personal responsibility for health care. (Side-Note: This is interesting because, as Laszewski notes, "the Massachusetts health reform bill [Romney] signed...does create a new and very large government program.")

So why, if 69 percent of Republicans say health care is a "very important" issue, do the presidential candidates on the right largely avoid talking about it?

One answer, which Laszewski hints at, is that the GOP base is made up mostly of the 1/3 of Republicans who don't see health care as a "very important" issue, and therefore hitting on the topic isn't necessary for winning the GOP nomination.

While I think there's some truth to that, I don't think that tells the entire story. After all, winning the nomination is just one piece of winning the presidency. It would greatly benefit a GOP candidate to start discussing health care, even if only as a side issue during the primary, so that a foundation on the issue is there when the general election rolls around.

But I'd say that the silence exists because it's extremely difficult to blend right-wing free market ideology with a proposal for universal health care. That's why you see Romney actually rejecting the very foundation of his own signature issue as governor of Massachusetts now that he's trying to court the GOP base.

The fact is the government is going to be an integral part of any universal health care plan, let alone one that fundamentally changes the system and, as a result, reduces costs. Simply relying on "market forces" to do the trick is little more than a pipe dream; to be sure, already 1 in 4 Americans relies on either Medicare or Medicaid for their health care, and another 15 percent don't have coverage of any kind.

As Froedtert Hospital CEO William Petasnick put it recently: "We've had 14 years of basically market-driven solutions. And market-driven solutions work up to a point, but I think the outgrowth of the failure of market-based solutions is . . . the 45 million Americans who are outside of the market."

The bottom line is that the government is going to be a necessary part of any viable fundamental health care reform plan. But proposing to use the government as a means for reform isn't anything the Republican base wants to hear.

It's been noted that the GOP candidates are going to have a tough time crafting a message on Iraq that pleases the base for the primary, and then reinventing that message to play to a wider audience in the general.

It seems the same may be true for the top domestic policy issue, as well.

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Blogger Dad29 said...


Romney may be keeping the issue out of the limelight because of the cost-overrun problems that MassCare encountered.

You know, the old "Government SNAFU" whereby a $1.00 lemon becomes a $2.75 lemon overnight.

"Sorry about that, old chap. We lied."

May 30, 2007  
Blogger Seth Zlotocha said...

The problem with MassCare is that it's not fundamental reform, it's merely building on the existing fragmented private system. It's extensive tinkering aimed solely at universal coverage, as opposed to fundamental reform that also addresses the underlying issue of cost by restructuring the system. Government involvement in reform, which is what Romney is backing away from now, has nothing to do with MassCare's troubles.

May 30, 2007  
Blogger krshorewood said...

If we want to frame this issue in order to attract more of the middle class, we have to start hitting on how the healthcare system we have has done financial damage. Case in point. There might be wait times for healthcare in Canada (not to the extent that critics in the US charge), but no one there has gone broke paying for treatments or drugs. In the US many families are one medical crisis away from financial disaster.

Furthermore many people are aware of the strain healthcare costs are putting on their employers to stay competitive and of the strain on providing raises. Just about everyone knows whatever raises they are getting are eaten up by increases in medical out of pockets and copays.

Coursing through the mass mind is that private sector has become a detriment to economic advancement in this country, and the more the GOP clings to private sector "solutions" to worse they will fare in 2008, providing Democrats know how to play their strong suit.

May 30, 2007  
Blogger Seth Zlotocha said...

I agree cost is the fundamental problem, and it's also the place Dems should be targeting their pleas for reform rather than the issue of morality (although that is important to point out, too).

But I don't think we want to set-up a public vs. private fight here. There's nothing wrong with private industry in health care; the issue is the fractions within the system that the various private players have been able to exploit on an increasing level for bigger and bigger profits. Of course, there's nothing inherently wrong with profits, but they should be kept in balance with the public's need for adequate and affordable health care. The only way to have that balance is to centralize the system; if there ends up being a centralized and privatized system, I don't see that as a problem.

May 30, 2007  
Anonymous John said...

I agree with this completely, thanks for the post.

May 31, 2007  
Blogger krshorewood said...

Indeed profit is one problem, but there is incredible waste within the system. One estimate puts it at 70%. This is due in part with the involvement of insurance companies and the paperwork monster they spawn. A US hospital may have 36 FTE's doing paperwork versus a same sized facility in Canada needing only two.

As Paul Krugman has pointed out, insurance companies seem to exist to keep people from getting healthcare rather than helping they pay for it.

HSA's will not be the answer. Supporters point to our system as being the best in the world, and indeed it is when it comes to treating medical problems. But we are much less effective at preventing them, and many HSA schemes seem to discourage preventive care.

May 31, 2007  
Blogger Seth Zlotocha said...

It's true our multiple payer system creates many inefficiencies. And if we were starting a system from scratch, I'd say single payer (at least for basic coverage) is the way to go (although that single payer wouldn't need to be public in order to realize administrative savings).

But since we're not starting from scratch, considering multiple payer options is necessary. And there would be an administrative difference between the fragmented multiple payer system we have now and a centralized multiple payer system. The latter would benefit from a far simpler administrative set-up since the total number of plans out there would be reduced as would the number of uninsured, and, if done correctly, the Medicaid system could be eliminated (a big cause of cost shifting in our current system is due to Medicaid, along with the uninsured).

And it should be remembered that not all HSAs are created equally. The bare bones HSA, as defined by law, is undoubtedly hazardous to the health care system, but wisely crafted HSAs with relatively low deductibles (no more than $1200-$1500 per person), free preventive care, and at least partially-funded balances can be beneficial. After all, payers and providers aren't the only players that can be wasteful in our current system -- there's a decent amount of patient waste, too (just visit any major ER in Milwaukee to see it in action -- there's plenty of people who don't need to be there who take time and resources away from people who do), and that's waste that can be at least partly addressed by wisely-crafted HSAs.

May 31, 2007  

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