Thursday, June 11, 2009

Conservative Republican Health Care Reform: These are the people telling us they want to protect us from rationing?

I've already written that the health care plan championed by Senator Teddy Kennedy (D - Massachusetts) leaves a lot to be desired at best. It seeks to rely on the dangerous crutch of corporate subsidization of employee health care while failing to address the major problems presented by our existing system. I likened it to the state health plan adopted by Massachusetts during the Mitt Romney administration, calling it 'Romneycare Plus.' Naturally, I stand by this attack. If the Kennedy plan is the best that the Democratic Party can produce, then the Democratic Party deserves a great deal of criticism on this issue.

The sad and tragic fact, however, is that the Republican plan being championed by conservative Senator Judd Gregg (R - New Hampshire) is far, far worse. Some of you may remember Senator Gregg, whom President Obama had nominated for Secretary of Commerce (and who first accepted and then repudiated that nomination in a manner that could not have looked more like a deliberate attempt to deceive and discredit the administration if the senator had been studying at the Actor's Studio in preparation for the performance) back when cabinet appointments were still the News Du Jour every day. Yes, that was a bit of an ad hominem attack. It doesn't prove the following argument in any way. It is, however, worth remembering.

Senator Gregg advocates a program called 'Coverage, Prevention, Reform' or 'CPR.' This program seeks to solve America's health care ills by penalizing working people and senior citizens in an attempt to force them to pay full price for private health insurance for which they would already be paying if it were within their means and met their health care needs; not to mention ignoring Medicare's highly successful competition with private health plans among those seniors who can afford them. They are not 'on the dole' because Medicare is cheap, if it were the failed and broken program described in the linked plug for CPR then very few of the people Senator Gregg wishes to force off of it would be on it in the first place . For those of you who doubt me in my description of CPR, please read the link. It is not a liberal analysis of the plan by left-wing advocates, but rather is an advocation of the plan as written by its conservative authors.

Take the following statement into account:

"Ultimately, this information would be used to tier Medicare copayments and deductibles to encourage beneficiaries to utilize 'higher quality more efficient providers.'" The single quotes within the larger quotation are mine, I want you to read the whole sentence and consider its meaning.

It is very difficult to come to any conclusion other than this: a primary focus of CPR is raising the price of Medicare for senior citizens to make them leave the program and purchase private insurance instead. Hardly the kind of health care reform desired in a system where the number one problem is economic access to health care due to consumer costs and the number two problem is rationing of service by for-profit providers in service to their bottom line. It should also be noted that there is in this sentence a tacit admission that private insurance cannot compete with Medicare on purely 'market' terms but must instead rely on government sabotage of Medicare.

There is a lot of repetition of the phrases 'preventative benefits' and 'disease management' in the text. They appear in bold print. Certainly these are necessary medical tasks that should be paid for, but they are not the sum total of American medical expenses and the simple fact is likely that preventative care is not the magic cure for health care costs that both liberals and conservatives claim to believe it will prove. I am certainly not dismissing the need for preventative care, but I am against siezing it as the sole great mantra of health care reform as is so popular. The reason the repetition of these phrases is so important, however, is because something is very clear about the thinking behind this plan: reading it suggests, to me, that its authors believe that the greatest victims of the American health care system are the private providers of health insurance and that the system must be reformed in their favor.

Why do I say this? For the bulk of Americans, this package amounts to an unfunded mandate to buy private health insurance. Despite repeatedly using the word 'quality' before the phrase 'health coverage', quality is never entirely or clearly defined. Indeed, the bullet point summary specifically reads:

"Designs a cost structure (not a benefit structure) in order to allow for flexible plan design." The emphasis is mine.

CPR contains no mechanism whatsoever to ensure 'quality health coverage' beyond the very subjective and limited areas of 'preventative benefits' and 'disease management.' In fact, despite the focus on preventative benefits, the Medicare portion suggests a belief that seniors are getting too much preventative care. Senator Gregg appears to think so. I quote:

"And physicians are paid more when they order more tests, procedures and office visits, whether you need them or not."

Many medications require frequent blood tests to monitor levels of medication in the patient's bloodstream. As an epileptic under medication for grand mal siezures, I can attest to this personally. Any visit to a doctor's office that I make inevitably entails a blood test. As a man on the wrong side of thirty, sugar and cholesterol tests are becoming more necessary as well. The preventative care requirements for such testing for seniors is greater than in my case as a thirty-two year old male. Not lesser. A certain number of office visits for check ups and progress reports are a necessary part of preventative health care for anyone, as well, moreso for seniors.

It should also be noted that someone is always paid more when physicians order more tests, procedures, and office visits... whether the physician is paid or not. Private insurance does not change this fact anymore than Medicare does. Either way, you pay a co-payment for every test, procedure, and office visit. Proper preventative care will mean more of these for most people (who do not see the doctor enough) rather than less. To be fair, Senator Gregg's specific indictment of Medicare's overuse of preventative care is not in the subject of the proposal as linked. However, it is a fair assumption that the attitude of a great advocate is based on belief in the substance of the object of his advocacy.

The most insidious part of CPR, however, is the secret tax hike. CPR makes health insurance premiums and care costs totalling over $11,500 a year per family or $5,000 a year per individual taxable income if you receive coverage through an employer-funded program and places the same ceiling on its proposed tax exemptions for health insurance premiums. Anyone who has any experience with health care costs realizes how low these numbers really are. Assuming an individual paid a premium of $100 per month (my share of the premiums paid when I had employer-paid care came to more, I am guessing most people's expenses do), then that means there is still $7,000 a year of premiums not at all covered by the tax exemption. Worse, some people require actual medical care beyond their premiums. Since the cap has already been eaten up by less than half the cost of premiums, none of this is covered. So the tax incentive for private insurance is essentially meaningless and the tax exemption for medical premiums on your payroll taxes is mostly history.

The result of all this is to make health care more expensive for most people, harder to get for most people, and to force the working class and senior citizens out of employer-paid care and Medicare and into the private market despite the fact that most of us can't afford private coverage in the first place and many of us can barely afford employer-paid coverage as corporations slough off more and more of the costs on their employees.

So where is the reform? And why are they talking about rationing care for seniors? Isn't that the horror story they use to scare people away from 'socialized medicine'? The notion of 'rationed care'? It looks like the biggest purpose would be to institute a system of care rationing to scare people away from 'socialized medicine' with which the oh-so-effective 'free market' cannot compete.

Something smells bad.