For some time now, the knee-jerk reaction of "liberals" (meaning, sundry fans/supporters/allies of the President and the Democratic Party) to the GOP's irrational, dishonest and hypocritical opposition to and criticism of the Affordable Care Act, has been to point out that the GOP has no "plan" of its own and to ask them, rhetorically, to articulate one. Meaning, the GOP has no idea how to accomplish, and has articulated no measurable concrete proposal for accomplishing, the three main goals of health care reform: (1) insure the uninsured, (2) bring costs down by reducing uninsured medical risk, and (3) end or curtail the more egregious consumer abuses perpetrated by insurers. How do you accomplish (1), (2) and (3) in a way that is more conservative, more "market-based," than the ACA, not to mention do it in a way that will not cost anyone anything?
My reaction to that has always been to point out that the GOP has no answer and no such "plan" because it doesn't actually want to accomplish (1), (2) or (3). Its goal is, and has always been, to keep the insurance, biotech and pharmaceutical industries profitable. The only way to do that in the face of ever-increasing demand for medical services -- the only commodity for which supply can never exceed demand -- is to serve fewer people, i.e., depress demand by pricing people out of the market. Rather than try to bring more people into the health care system, which would cost insurers, providers, manufacturers and already-insured consumers money no matter how you slice it, the GOP's goal is to keep people out of the system and serve only those who can already afford its exorbitant costs.
The best the GOP can usually do is trot out broad, vague, 35,000-foot-high-level abstractions like "patient-centered health care system" and "common-sense free-market solutions," which sound nice when spoken to David Gregory over and over again but don't tell us much in the way of actual policy, let alone actual legislation. Ask them to get more specific and they recite the same boilerplate proposals over and over again, which are only slightly less rhetorical and abstract: "tort reform," "sell insurance across state lines," "health savings accounts" and, of course, "tax credits."
None of these have actually worked where and to the extent they've been tried, and the first two can't really be accomplished by federal legislation anyway since they're the purview of state courts and insurance commissioners, respectively. Mainly, though, the common thread in these "proposals" to the extent they have any meaning at all is that they would benefit providers, manufacturers, insurers, and people who already have health insurance, can already afford it and don't really need to use it. None of these things, even if it could be put into actual practice as actual policy by federal legislation, would get a single uninsured person insured, make insurance affordable for anyone who can't already afford it, or give anyone peace of mind who doesn't already have it that their insurance will be there when they need it and that medical costs will not break them.
Which brings us to the latest Republican attempt to prove that they do, in fact, have an actual "plan" that is an actual alternative to "Obamacare." Follow me below the fold to see what a "patient-centered health care system" would look like after President Cruz signs it into law in 2017.
Now, finally, the GOP has a "plan" of its own that goes a bit further beyond rhetorical abstractions. As reported and described by the National Journal:
A trio of Senate Republicans on Monday introduced their plan to replace Obamacare with a new system that is built largely around making individuals responsible for a higher portion of their health care costs.Reading the National Journal report and others, I think that's a pretty fair assessment of the plan's "essence." My sense of it is this: Have consumers (i.e., patients) pay more, and have employers and insurers pay less, thus the system becomes more "patient-centered." Eliminate regulations and consumer protections, leave it up to consumers to protect themselves, thus creating a more "patient-centered" system.
In essence, the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or "sensitizing" consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.
Most people don't recognize how much their employer contributes to their health care plan and don't see the costs the insurance company covers: If people are spending more of their own money, many conservatives argue, they'll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more "skin in the game."
The theory seems to be that if you give consumers more "skin in the game," they'll make better choices about whether, when, where and how to spend their health-care dollar, and the cumulative effect thereof will be to bring costs down. Setting aside the wishful-thinking aspects of this theory, it should at least be pointed out that most consumers are not physicians, medical experts or insurance actuaries. One of the reasons why we have commercial regulation and consumer protection in the first place is that we don't expect people to become experts on everything they might think about buying. For all the braying we hear from the Right about the "nanny state," and the "government telling you what's best for you" and what-not, the fact is that sometimes we do need experts to help us make good choices and prevent us from making bad ones. But I'm not here to launch into a consumer-advocacy dissertation.
What concerns me about this "plan" is that at its core, its "essence" is to require people to take greater risks with their health. Again, the plan is to make people shoulder more of the actual costs of their own medical care, relying less on their employers and insurers to cover them. The purpose of that is to make people more aware and conscious of what their care actually costs, so they'll "be smarter consumers" and "make better choices" in the marketplace. Meaning, and I really can't think of any other meaning, we want people to think twice about seeking medical care when they get sick or injured. We want people to have to decide whether they really, really feel they really, really need treatment and whether it's really, really worth the money before they call a doctor or go to the ER.
I do have to applaud the GOP for coming up with a "plan" that really is an ideological alternative to the right of the ACA. I always understood that the underlying goal of health-care reform was to reduce risk for patients, to give people peace of mind that they can get treated when they get sick or injured and that it won't bankrupt them in the process. Indeed, one of the rationales behind the individual mandate and minimum-coverage regulations in the ACA (you know, the ones that "forced" insurers to "cancel" all those plans that people "liked") is that we don't want people to take risks with their health, and we won't allow people to take risks with their health anymore because when they lose, we all lose. This "plan" that the GOP has come up with does the precise opposite. In encourages, if not outright compels, people to take chances with their physical well-being.
I honestly can't think of another meaning or rationale for the "skin in the game" aspect of the GOP's "plan." The ACA's goal [whether it can or will accomplish same being an open and separate question] is and has been to relieve people of the burdens and risks associated with medical care and its costs; to shift some of those risks and burdens from patients to insurers, employers, providers, manufacturers and government -- all of which are in a better position to bear them than any individual consumer. The goal of the GOP plan appears to be the precise opposite, viz., make individual consumers take greater risks and bear more of that burden, while making insurers, employers, providers, manufacturers, and government bear less of it.
I guess that's what they mean by a "patient-centered health care system."