By Philip Klein on 10.2.09 @ 6:09AM
Republicans have weakened support for Obamacare, but they have
done nothing to advance an alternative view of the U.S. medical
system.
Republicans may be scoring tactical victories in the current
health care debate, but they are no closer to winning the
long-term battle over the future of the nation’s medical system.
In 1994, Republicans defeated President Clinton’s health care
proposal and took back Congress. But once that happened, the
attitude was that they dodged a bullet, and for 15 years
Republicans made no major effort to overhaul our over-regulated
mess of a health insurance market. To the extent that they did
act on health care, it was to pass the largest expansion of
entitlements since the Great Society in the form of the Medicare
prescription drug plan.
For the past several months, the Republican critiques of
President Obama’s health care plans have centered on issues such
as “death panels,” coverage of illegal immigrants, subsidies for
abortion, and proposed Medicare cuts. Taken together, these
criticisms have helped to weaken support for and build opposition
to Democratic initiatives, but they have done nothing to advance
an alternative vision for the health care system.
There’s a clear political rationale for the minority party
wanting to avoid uniting around an alternative proposal that
could be a huge target while having no real chance of passage.
During the 2005 Social Security debate, Democrats merely hammered
away at President Bush’s proposals rather than offer their own
plan to address the crisis.
In lieu of uniting around a single alternative bill, it’s true
that some Republicans have presented alternative proposals for
reforming the nation’s health care system. But the problem is,
when Republicans throw out catch phrases such as “consumer-based
health care,” or propose changing the tax code and allowing
individuals to purchase insurance across state lines, it doesn’t
really mean anything to most people who don’t pay attention to
the intricacies of health care policy. Thus, before Republicans
will even be in a position to present alternate solutions, they
have to familiarize Americans with an alternate narrative about
the problems with the current health care system.
Democratic proposals are focused on getting more Americans health
insurance, but about 90 percent of the country’s citizens are
already covered. What really is at the center of the nation’s
health care crisis is the sense of powerlessness that individuals
feel when interacting with the convoluted U.S. medical system.
And that’s a problem that affects nearly everybody, even if they
have insurance and do not have a preexisting condition.
In 2008, 176 million people, or 58 percent of Americans, obtained
health insurance through their employers, according to Census
data. While these people are viewed as being among the lucky
ones, the reality is that they don’t have much health care
freedom. In general, workers have to enroll in whatever health
care plan their employer offers them -- or maybe if they’re
really lucky, they’ll get to choose among several plans. Once
enrolled in the plan, they have to pick a doctor from a list of
physicians who participate in that given plan, and often they
have to make that choice blindly. The reason is that even though
Americans have numerous resources at their disposal to decide
which DVD player to buy, which hotel to stay at, or which
restaurant to eat dinner at, they don’t have as many ways to find
out which doctor is best for them.
In addition to the lack of choice, those with employer-based
health insurance face the prospect of losing health coverage and
doctors they are happy with if they switch jobs, and losing
coverage altogether if they are let go.
Those who do not have health insurance through their employers or
do not qualify for government health coverage are forced to
navigate the individual insurance market. Not only do they start
off at a disadvantage because they do not get the same tax
benefits as they would if they obtained coverage through their
employers, but they have only a limited amount of choices.
Most states place onerous regulations on insurance policies that
require them to cover certain benefits government deems
essential. There are over 2,000 of these benefits nationwide,
which drive up the cost of health coverage by 20 percent to 50
percent,
according to the Council for Affordable Health Insurance.
That means that young and healthy people who may want basic
health insurance plans with lower monthly premiums are forced by
government to either buy a plan with a price tag that far exceeds
their health care expenditures, or go without insurance, as many
do.
Thus, the way the health care system functions in this country is
completely different from the way any other part of the economy
functions. Everywhere else, American consumers face a dizzying
array of choices and they have the freedom to buy what they want,
and the ability to shop around for the best price. But when it
comes to health insurance, people can’t buy the coverage that
they want, but the coverage that the government says they need.
Americans should have a health care system that allows them to
exercise the same freedoms that they do in other parts of the
economy. A system in which they could choose insurance policies
that best fit their needs, take their policies with them from job
to job, and hang on to them when they are between jobs.
Such a system would not only have benefits for the individual,
but would remedy many of the problems facing the nation as a
whole. If individuals had more control over their health care
dollars, then they’d have more of an incentive to shop around for
the best price for medical services and less reason to abuse the
system by seeking unnecessary care. And while under the current
system insurers expect to lose their customers every few years as
they change jobs, in a free system insurers could potentially
maintain somebody’s business for life. If that were the case,
then suddenly insurers would have more of an interest in
providing incentives to individuals to make healthier lifestyle
choices such as losing weight and quitting smoking -- the type of
preventive measures that would help ease the strain on our health
care system.
Only if Americans understand how much government meddling there
is in the health care system and how an alternative system could
function can Republicans begin to make the case for ideas such as
allowing Americans to purchase insurance across state lines and
ending the discrimination in the tax code against individuals who
buy health insurance on their own.
While it’s unrealistic to believe that any such ideas could make
it into any of the current Democratic bills, Republicans should
take advantage of this time when the whole nation is focused on
the health care debate to lay out a different vision. If they
don’t seize this opportunity, they will continually be playing
defense on the most important domestic issue of our time.
topics:
Health Care, Republican Party
