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The six Republican ideas already in the health-care reform bill

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At this point, I don't think it's well understood how many of the GOP's central health-care policy ideas have already been included as compromises in the health-care bill. But one good way is to look at the GOP's "Solutions for America" homepage, which lays out its health-care plan in some detail. It has four planks. All of them -- yes, you read that right -- are in the Senate health-care bill.

(1) "Let families and businesses buy health insurance across state lines." This is a long-running debate between liberals and conservatives. Currently, states regulate insurers. Liberals feel that's too weak and allows for too much variation, and they want federal regulation of insurers. Conservatives feel that states over-regulate insurers, and they want insurers to be able to cluster in the state with the least regulation and offer policies nationwide, much as credit card companies do today.

To the surprise and dismay of many liberals, the Senate health-care bill included a compromise with the conservative vision for insurance regulation. The relevant policy is in Section 1333, which allows the formation of interstate compacts. Under this provision, Wyoming, Colorado, Arizona, Utah, and Idaho (for instance) could agree to allow insurers based in any of those states to sell plans in all of them. This prevents a race to the bottom, as Idaho has to be comfortable with Arizona's regulations, and the policies have to have a minimum level of benefits (something that even Rep. Paul Ryan believes), but it's a lot closer to the conservative ideal.

(2) "Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do." This is the very purpose of the exchanges, as defined in Section 1312. Insurers are required to pool the risk of all the small businesses and individuals in the new markets rather than treating them as small, single units. That gives the newly pooled consumers bargaining power akin to that of a massive corporation or labor union, just as conservatives want. It also gives insurers reason to compete aggressively for their business, which is key to the conservative vision. Finally, empowering the exchanges to use prudential purchasing maximizes the power and leverage that consumers will now enjoy.

(3) "Give states the tools to create their own innovative reforms that lower health care costs." Section 1302 of the Senate bill does this directly. The provision is entitled "the Waiver for State Innovation," and it gives states the power to junk the whole of the health-care plan -- that means the individual mandate, the Medicaid expansion, all of it -- if they can do it better and cheaper.

(4) "End junk lawsuits." It's not entirely clear what this means, as most malpractice lawsuits actually aren't junk lawsuits. The evidence on this is pretty clear: The malpractice problem is on operating tables, not in court rooms. Which isn't to deny that our current system is broken for patients and doctors alike. The Senate bill proposes to deal with this in Section 6801, which encourages states to develop new malpractice systems and suggests that Congress fund the most promising experiments. This compromise makes a lot of sense given the GOP's already-expressed preference for letting states "create their own innovative reforms that lower health care costs," but since what the Republicans actually want is a national system capping damages, I can see how this compromise wouldn't be to their liking.

(5) To stop there, however, does the conservative vision a disservice. The solutions the GOP has on its Web site are not solutions at all, because Republicans don't want to be in the position of offering an alternative bill. But when Republicans are feeling bolder -- as they were in Bush's 2007 State of the Union, or John McCain's plan -- they generally take aim at one of the worst distortions in the health-care market: The tax break for employer-sponsored insurance. Bush capped it. McCain repealed it altogether. Democrats usually reject, and attack, both approaches.

Not this year, though. Senate Democrats initially attempted to cap the exclusion, which is what Bush proposed in 2007. There was no Republican support for the move, and Democrats backed off from the proposal. They quickly replaced it, however, with the excise tax, which does virtually the same thing. The excise tax only applies to employer-sponsored insurance above a certain price point, and it essentially erases the preferential tax treatment for every dollar above its threshold.

(6) And finally, we shouldn't forget the compromises that have been the most painful for Democrats, and the most substantive. This is a private-market plan. Not only is single-payer off the table, but at this point, so too is the public option. The thing that liberals want most in the world has been compromised away.

On Sunday, John Boehner and Mitch McConnell responded to Barack Obama's summit invitation by demanding Obama scrap the health-care reform bill entirely. This is the context for that demand. What they want isn't a bill that incorporates their ideas. They've already got that. What they want is no bill at all. And that's a hard position for the White House to compromise with.

Photo credit: AP Photo/Harry Hamburg.

By Ezra Klein  |  February 8, 2010; 10:26 AM ET
Categories:  Health Reform  
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Comments

Yes, When president Bush urged both parties and all interest groups to join in a national conversation on Social Security reform, the Democrats responded with many of their own alternatives, came to the bargaining table in a spirit of bipartisan cooperation and declined to use the issue as a campaign tool to bludgeon Republicans in 2006. Except they did the exact opposite. Democrat leaders refused to even discuss the issue unless they could score a quick victory by forcing the Preseident to take SS accounts off the table. They immediatly launched fundraising and issue campaigns using the issue and directly attacked the Republican base in a successful effort to retake both Houses of Congress. What goes around comes around. Democrats deliberately obstructed Social Security reform to gain an electoral advantage. They have no cause to complain if Republicans do the same with their pet projects.

Posted by: WoodbridgeVa1 | February 8, 2010 10:40 AM | Report abuse

"End junk lawsuits" is not meaningful. Cap outrageous damages that drive up healthcare costs for everybody--that's meaningful.

The problem is not the number of Republican ideas included, but the number of Democrat ideas included. Get rid of all the Democrat ideas, and maybe the Republicans would vote for it. Maybe.

But there is a rational reason for the Republicans to vote against healthcare reform that includes amendments that they are for and that they put in there--that is, they want to maintain the status quo. Irrespective of the wisdom of that position, let's say that's their main goal. Then they will fight HCR no matter how many Republican ideas are incorporated (arguing that compacts and whatnot don't go far enough). However, the acknowledge that it is possible that HCR will pass. So, they also do everything they can to minimize the "negative" effects of HCR and also include laws, regulations and changes that they think will be "better than nothing" or will help mitigate the issues they feel might crop up with other parts of the law.

That is, their best case scenario is that any compromise HCR legislation is defeated, and the status quo is maintained.

Their second choice (that is, the back up plan) is that the legislation feature as many of their policy initiatives as possible, so that if it does pass, those initiatives become law. This has the political advantage of allowing them to take credit for what works, if anything, and blame the Democrats for everything that doesn't.

The third choice is that HCR is passed, is a mess, becomes very unpopular and fails dramatically and costs the Democrats at the ballot box.

The worst case scenario is that HCR reform is passed, works well (or appears to work well, with the negative effects being effectively ignored--sort of like the Democrats authoring the subprime mortgage industry) and the Democrats get to take credit for this wonderful piece of legislation.

So the Republican strategy makes a certain kind of sense, and also indicates that they will not negotiate in good faith for any kind of healthcare compromise. All their healthcare negotiations are a form of insurance against HCR actually passing, not an effort to craft legislation that they can then vote for.

Posted by: Kevin_Willis | February 8, 2010 10:43 AM | Report abuse

"After all, including legal fees, insurance costs, and payouts, the cost of the suits comes to less than one-half of 1 percent of health-care spending."

As soon as somebody uses this argument to defend the tort system, we're no longer dealing with reality. The cost of tort is in the overuse due to defensive medicine, not the cost of the suits.

Dems want outcome based reimbursement -- that's stated policy. And the Dem approach to tort reform is outcome-based. Lawsuits have become a profitable way to test unfavorable outcomes for malpractice. The true cost is in the crossing of t's and dotting of i's necessary to establish up front that bad outcomes are not the doctor's fault.

Posted by: cpurick | February 8, 2010 10:44 AM | Report abuse

Woodbridge, health care and health care financing reform are national issues that loom on a pretty near term horizon much more than "social security reform" ever was. There was not a "national conversation" on social security reform after the 2004 election, there was a poorly made case from the Bush White House that the issue existed.

Posted by: bdballard | February 8, 2010 10:45 AM | Report abuse

You are wrong about #1, Ezra. The legislation does not allow people to buy insurance across state lines. If it did, it would end the power of states to ban its citizens from doing this. Instead, the legislation does nothing to end states' power to interfere with interstate commerce. Sure, it says they can form compacts, but they could do that under current law. In fact, under current law any state could allow its citizens to purchase insurance in another state. None do.

No state will enter into these compacts because no state wants to give up its authority. If you were correct about this point, the the legislation would define the purchase of health insurance as interstate commerce (it's hard to see why it's not) and thus end the states' ability to interfere with it.

Posted by: marckil | February 8, 2010 10:46 AM | Report abuse

Well Ezra, thanks for admitting what progressives have been saying all along. The White House and Congressional Democrats in both houses chose to give the middle finger to progressives and labor and took reconciliation off the table right from the start, in order to write conservative (and bad) bills they hoped could get 60+ votes in the Senate. Now that their gamble has failed (as foreseen by many), don't come whining to the same progressives whom you previously told to take a hike for help in passing your lousy Republican legislation.

Posted by: labonnes | February 8, 2010 10:48 AM | Report abuse

Is this a concession that the House bill is dead and that the Senate bill, as it stands now without House amendments, should be made law?

I ask because it seems that the Senate bill takes an approach different than that of the House bill. On the GOP website you referenced appears a file (http://gopleader.gov/UploadedFiles/a_tale_of_two_approaches.pdf) which compares provisions of the original House (not Senate) bill with other (ostensibly valid) ideas: is Pelosi holding the HCR bill hostage in order to gain any of the apparently controversial elements?

To be clear, I'm concerned that the Senate HCR bill has already passed... a mere majority of Representatives could vote to accept it, but aren't willing to do so, even though failing to do so puts live at risk. Again, Democrats -- not Republicans -- are currently holding the legislation. What's THEIR issue -- what missing provisions do (Democratic Party) members of the HOUSE demand?

Posted by: rmgregory | February 8, 2010 10:49 AM | Report abuse

Ezra, can you get better liars, please?

The tort-reform / defensive medicine has been disproven over and over. Docs get paid more the more they do, period.

And social security -- oh yeah, it is so terrible the Dems blocked putting social security into the hands of Bear Sterns! Boo-freakin'-hoo!

And that was definitely the main concern, as Bush turned record surpluses into record deficits.

Posted by: AZProgressive | February 8, 2010 10:49 AM | Report abuse

On all those "TORT REFORM" fanatics, I'd love to know what they say if a crappy doctor somewhere operates on them and hacks off the wrong leg, gives them the wrong medicine (which puts you in a coma), operates on the wrong lung, leaves an surgical instrument in your stomach, or forgets to sterilize the operating room properly and you die of an infection.

I'm sure the capped damage of $100,000 would be sufficient for your wife, and 4 year old twins to live by.

Yea. I'm sure that's why the cap is so useful.

It's probably why in Texas, where there is a cap, THERE'S BEEN NO DECREASE IN HEALTH COSTS!!!!!

.........I really wish people knew what they were talking about when they swear by one solution vs another. But then again, that would mean that they would be able to blog about it, rather than rant and rave incoherently about it on the comments section of the blog.

Posted by: JERiv | February 8, 2010 10:53 AM | Report abuse

Woodbridge,

The problem I foresee with the Republican strategy of resisting HCR they way the Democrats resisted any form of Social Security Reform is that the Republicans are upping the ante across the board, and I expect the Democrats will do so, next time.

I expect they will relish being the party of "no", next time around. Compromises aren't pretty (I'd love it if the Bush tax cuts didn't expire, or if No Child Left Behind hadn't been 90% written by Ted Kennedy, or if Ronald Reagan hadn't raised the capital gains tax while cutting income taxes), but when there are no compromises at all on anything, almost nothing positive will get done. Ever.

Unfortunately, the one thing Republicans and Democrats can bi-partisanly agree on is that the other party should never achieve any significant form of legislation, ever.

While I like this for healthcare reform (although this bill, messy though it is, is a million times better than Clinton-care, which included a Soviet-style Central Planning for the government to decided where physicians went to school and what specialty they studied and where they had to go work), I didn't like it for Social Security Reform. So, I want Social Security Reform, Ezra wants Healthcare Reform, and apparently these are things we can't compromise on, so we won't get either of them.

I listened to a 1964 Ronald Reagan campaign speech for Barry Goldwater yesterday. It's on YouTube, if you go look for it. It lasts 30 minutes. It is amazing, listening to that speech, how well-trod this ground is. He could be Paul Ryan complaining about Obama, just about. He even says, and I quote: "Some call us 'the party of no'". Seriously. 1964. Look it up.

Posted by: Kevin_Willis | February 8, 2010 10:56 AM | Report abuse

"The tort-reform / defensive medicine has been disproven over and over. Docs get paid more the more they do, period."

Right. And my family practitioner sends me to the radiologist because he wants the radiologist to get paid more; not because he might get sued for not ordering a scan.

Get real.

Posted by: cpurick | February 8, 2010 11:18 AM | Report abuse

It's interesting that the states who don't like HCR plan to resist via the 10th amendment, but the Republican plan overrides state laws for tort reform and selling across state lines and this isn't a big problem. If the federal government can declare insurance and interstate commerce, it can declare anything at all interstate commerce (sears home repair can use plumbers licensed in SD and not IL). They probably can anyway.

On tort reform, an OB/GYN who screws up or is unlucky can have an injured infant with millions of medical costs through its life. With HCR and no ban on preexisting conditions, we all pay for this outcome, so the child is exposed to say $400,000 in medical costs in it's like ($5,000 *80 for an individual plan plus out of pocket). At any rate, wouldn't defensive medicine kick in out of fear of a couple of $million lawsuit for actual bills? Would you really refrain from covering yourself if your liability was in the millions and not tens of millions.

Posted by: windshouter | February 8, 2010 11:19 AM | Report abuse

JERiv,

you know you're right. Costs in Texas (like everywhere else) are still going up. But the problem with your assumption is that there's more than lawsuits (junk or otherwise) that affect costs. No one that's sensible is saying that if we had tort reform that costs would drop 30%. We're saying it needs to be reviewed and Ezra putting up as an option "end junk lawsuits" really isn't right and the Republican's aren't right to say it that way. As Kevin Willis basically says we need to make sure legitimate lawsuits continue and those injured by doctors get a reasonable amount to take care of whatever special needs they'd have but not a catastrophic amount based upon a sympathetic jury.

Posted by: visionbrkr | February 8, 2010 11:21 AM | Report abuse

"Bush turned record surpluses into record deficits."

Help me out, AZ. I keep looking at the charts and I can't find these "surpluses" you speak of. Which fiscal years ended with the lower debt that would define a surplus?

Posted by: cpurick | February 8, 2010 11:23 AM | Report abuse

The reasons the Dems opposed Social Security reform is because they felt the status quo was fine. They also made it clear that was their position.

If the Republicans believe the status quo is fine on health care, then they should be honest about it. But they won't because they know the status quo is broken and they're willing to have millions of people suffer so they can a gain political win.

Posted by: SteveCA1 | February 8, 2010 11:24 AM | Report abuse

"Which fiscal years ended with the lower debt that would define a surplus?"

`When I use a word,' Humpty Dumpty said, in rather a scornful tone, `it means just what I choose it to mean -- neither more nor less.'

Posted by: labonnes | February 8, 2010 11:29 AM | Report abuse

Part of me thinks the solution is to give the Thuglicans everything they want. Adopt a bill they write. When that fails, as it surely will, then we can move on.

Of course, it will take years for the failure to be apparent and many will die due to lack of health care. Millions will lose every thing they own due to out-of-control health care costs.

In the meantime, though, unregulated insurers will make billions.

Do you see how opportunity really works in a Thuglican world?

Posted by: amelia45 | February 8, 2010 11:56 AM | Report abuse

amelia,

do you realize how silly you sound saying insurers are "unregulated" in an industry that has some of the most stringent regulations outside of utilities.


Maybe we're all worried about becoming the next Greece and really want to control costs.

http://www.nytimes.com/2010/02/07/business/global/07greece.html?scp=2&sq=greece&st=cse

Posted by: visionbrkr | February 8, 2010 12:10 PM | Report abuse

The mandate is an absolute deal-breaker. It is immoral to force healthy 25 year olds to buy comprehensive health insurance. Case closed.

Posted by: yourstruly1991 | February 8, 2010 12:14 PM | Report abuse

Sure glad Obama took single payer off the table right at the start. So "winning" for the Republicans means killing the bill outright but "losing" means getting a bill that incorporates a bunch of their policies. This is a pretty great place for a repudiated minority party to be, no? I can't recall the Democrats ever being in a position nearly so advantageous when they were in the minority.

Posted by: NS12345 | February 8, 2010 12:19 PM | Report abuse

yourstruly1991, the mandate is the only way to get the regulations that eliminate the other horrible practices of the insurance industry. But if it bothers you that they're being forced to buy something, I'd be happy to just have a system paid for directly through taxes.

visionbrkr, I think amelia meant that in her hypthetical where Republicans "got everything they want" that the system would fail, but that insurers would get rich because the currently existing regulatory structure would be eliminated.

Posted by: MosBen | February 8, 2010 12:31 PM | Report abuse

Aw come on ... it doesn't matter what verbiage Republicans put on a web site. They have an obvious health plan, well stated by Alan Grayson: "Just die." That is, unless our sponsors can fleece you first ...

Posted by: janinsanfran | February 8, 2010 12:37 PM | Report abuse

MosBen,

Are Republicans really asking for NO regulation of insurers? I don't think that's the case. I do think though that if Republicans got "everything they wanted" that the system would fail. I think the CBO report on the "republican house plan" was probably pretty spot on.


I do agree wholeheartedly with you on the response to "yourstruly1991". I wonder if he or she would be saying the same thing if they were a 50 year old with heart disease and a quadruple bypass on their "resume" and was uninsurable in many states. That being said someone's going to have to "pay" when you get no appreciable benefit out of it when necessary reforms are done to end pre-ex.

In MA for example the young invicinbles weren't happen but they went along and now they have a system that while be far from perfect is one of the best in the country.

Posted by: visionbrkr | February 8, 2010 12:38 PM | Report abuse

@amelia: "Part of me thinks the solution is to give the Thuglicans everything they want. Adopt a bill they write. When that fails, as it surely will, then we can move on."

I expect the Republicans would also vote against their own bill at this point, just to deny Obama any win on healthcare. Their optimum outcome is no healthcare bill, at all.

That being said, I don't get the appeal of calling political parties clever names like Thuglicans or Repugnicans or Democraps. Or Commiecrats. Or Surrendercrats. Seems superfluous.

Posted by: Kevin_Willis | February 8, 2010 12:39 PM | Report abuse

i just read your malpractice article that you linked to earlier and it seems pretty convincing that the lawsuits themselves are only a fraction of the cost of healthcare.

But that seems to be only one part of the equaiton. How much of the cost of health care is due to doctor's treating patients in such a way to prevent lawsuits versus how much treatmetn is necessary?

Do doctors' overtreat patients as a way of protectign themselves against lawsuits that could occur? This would seem to raise the cost of health care if it is common.

Posted by: DropItLikeItsHot | February 8, 2010 12:45 PM | Report abuse

visionbrkr,
As compared to other industrial nations like Germany, Switzerland, the Netherlands, Japan, that deliver basic health insurance through non-government agencies, the US insurance industry is very lightly regulated. They have functional universal health systems...we do not. Case closed.

Posted by: michaelterra | February 8, 2010 12:47 PM | Report abuse

Free market. lol This from the same auhor who said if we didn't pass HC is comparable to genocide.

Posted by: iacoboni04 | February 8, 2010 12:50 PM | Report abuse

michaelterra,

that's nice what you say and all and absolutely correct but it doesn't change the fact that amelia said insurers in the US were "unregulated" which is 100% FALSE.

You could also add that doctors, pharma etc are very "lightly regulated" in the US if you truly wanted to be factual and complete as the insurers are not the main reason for the cost but almost always get the lion's share of the blame.

Posted by: visionbrkr | February 8, 2010 12:54 PM | Report abuse

@janinsanfran: As opposed to the Democratic health plan, which is, "Just die if you're old." Or, "Take a pill. Then just die. If you're old."

As that was, essentially, Obama's prescription for one particular 100 year old woman on his healthcare television special. Which, admittedly, is pretty old.

Although I tend to suspect that the majority of people on pretty much every side of the political spectrum don't think that "just die" makes for any kind of approach to healthcare, be it individual, group or societal. Nor is arguing against the hybrid house and senate bills the equivalent of telling sick people that they just need to die.

Frankly, that sort of characterization tends to justify the Republican highly partisan approach (and vice versa)--why even try to appeal to that segment of the ideological spectrum that thinks you actively want to kill people? There's no winning them over, just as there is no winning folks over who say Democrats are actively trying to destroy the country. What's the point in those folks every trying to meet in the middle? There's no middle for them to meet at. And they tend to push the folks who are a little closer to the middle out to the edge.

I don't see any point in having a dialog with someone who thinks, because I disagree with them, I want people to die. Especially old people, poor people, brown people and children.

Someone on the other isn't going to see any point in compromising with me, if I tell them that they are intentionally trying to destroy the country and sell us out to terrorists.

Thus, we're just gonna fight, tooth and nail, and if there is ever anything left after the dust settles, that maybe will get passed into law. Maybe. But no promises.

Posted by: Kevin_Willis | February 8, 2010 12:55 PM | Report abuse

Ezra, the President might be well-advised to do two additional things:

(1) Say publicly that "scrapping the bill is silly, it's got lots of bipartisan ideas, and if the Republicans don't want to honor these existing compromises, then the voters should chuck them out of office," and

(2) after the next televised healthcare summit, say "That's it. The buck stops here. We'll put your x,y,z into the package too, and let's pass it tomorrow. No more politics."

There should be no more time delays!!

Posted by: Lee_A_Arnold | February 8, 2010 12:57 PM | Report abuse


TO: WoodbridgeVa1 who wrote:
“…When president Bush urged both parties and all interest groups to join in a national conversation on Social Security reform … forcing the Preseident to take SS accounts off the table…”
____________________________

Why again, are the psychos trying to blame Democrats – Your memory fails you because there was a cry heard all over the nation that NO ONE, but NO ONE trusted Bush with Social Security, and if we had done what Bush wanted to do, which was invest it in the Stock Market, we wouldn’t HAVE any retirement funds by now.


Posted by: lindalovejones | February 8, 2010 1:24 PM | Report abuse

Re woodbridge #1

Yes, When president Bush urged both parties and all interest groups to join in a national conversation on Social Security reform, the Democrats responded with many of their own alternatives, came to the bargaining table in a spirit of bipartisan cooperation and declined to use the issue as a campaign tool to bludgeon Republicans in 2006. Except they did the exact opposite. Democrat leaders refused to even discuss the issue unless they could score a quick victory by forcing the Preseident to take SS accounts off the table. They immediatly launched fundraising and issue campaigns using the issue and directly attacked the Republican base in a successful effort to retake both Houses of Congress. What goes around comes around. Democrats deliberately obstructed Social Security reform to gain an electoral advantage. They have no cause to complain if Republicans do the same with their pet projects.

This ignores the primary difference-- social security is not in crisis, and health care/ health insurance is

Posted by: jamie_2002 | February 8, 2010 1:53 PM | Report abuse

I'm just curious which lawsuit is "junk"?

I might also add that Bush -- purposely -- never mentioned anything about Social Security during his campaign. In addition, Bush never came up with a "plan" for social security. He simply said, "social security is bankrupt and I want to privatize it."

Similarly, the Republicans are very cagey about the fact that they don't actually want to reform health care and never wanted to. If they'd just be up front about that, then we could have a real debate about the issue, a debate that they would lose.

Posted by: tyromania | February 8, 2010 2:12 PM | Report abuse

The 'Reform' is not a reform:

Item 1:
 “A mere seven months ago (that would be around June 2009), The New York Times/CBS poll found that 72% of Americans ‘supported a government-administered insurance plan—something like Medicare for those under 65—that would compete for customers with private insurers.’”

Item 2: As of February 2010, no single payer health care reform, no 'government option', mandated premium payments to private sector insurers, tax money to private sector insurers, stipulations making it legal for insurers to spend only 80 cents of every 100 cents on actual health care while spending 20 cents of every 100 cents on lobbying, 'sympathetic' candidates, CEO bonuses, 'administration' and fighting your claim for treatment.

Item 3: Virtually no one (other than those who created the sop for themselves) want this bastardized insurance industry bailout to pass.

Question: Under 'reform', citizens must purchase premiums from the private for-profit insurance industry under penalty of law, tax money will given to the industry if individuals cannot afford to pay the corporations, 20% of every dollar can be spent by the private insurance corporations on non-health care (bonuses, lobbying, fighting claims, etc.); so, what would make it more 'Republican'?

Answer: Limited citizens' rights to go to court for malpractice! Sure. That will insure virtually complete citizen subservience to the health insurance industry.

You go Obama! Hope you've got your spinmeisters working over time on this one.

Posted by: theworm1 | February 8, 2010 2:20 PM | Report abuse

Ezra,
This comment is not so much about the content of the post, which I found generally helpful but more with your seeming desperate efforts at points recently to "court" or "be open to" Republican views and suggestions. In theory I have no objection to the latter but when you are "open to" Republican "ideas" make sure that you put them in context. Most Republican ideas in the last 3 years (and before) seem designed to hamstring government (as noted by Krugman in today's Op-Ed). Republicans only occasionally show an interest in governing and given that context, the occasional ray of light that emerges seems to have the effect of intellectual "bait" for people like you.

Please, Ezra, become more aware of taking this "intellectual bait" and provide a little context when you suddenly discover that a Republican had an idea that at least you think might be an honest effort to improve the lives of Americans. Sometimes those proposals are not really honest.

Posted by: michaelterra | February 8, 2010 2:31 PM | Report abuse

visionbrkr, just to clarify, I don't necessarily agree with amelia that "what the Republicans want" is for a completely unregulated insurance market, though I think their ideas would lead to a market that I would consider dangerously underregulated. I was just pointing out that she was saying that "no regulation" is what the Republicans want, not the system that's currently in place. Your follow up comment to michaelterra also seems to imply that amelia said that the insurance market is *currently* unregulated. I don't think that's what she meant.

If I'm misunderstanding your point, then my bad.

Posted by: MosBen | February 8, 2010 2:48 PM | Report abuse

Be careful what we ask for. Allowing purchases of health insurance across state lines will do much of the same as when we allowed banks to cross state lines. The largest banks took over and started the financial mess we are now in. The largest insurance companies will rule.

Posted by: cpbis | February 8, 2010 2:55 PM | Report abuse

"Help me out, AZ. I keep looking at the charts and I can't find these "surpluses" you speak of. Which fiscal years ended with the lower debt that would define a surplus?"

2000 - the US budget called for less spending (inlcuding servicing debt) than income from taxes, hence a "surplus." 2001 - after Bush tax cuts, US budget called for more spending than income from taxes. And each successive year got worse, even with two wars being paid for off the books (thought the debt they incurred increased spending to service it).

Is it really all that mysterious?

Posted by: tdbach | February 8, 2010 3:08 PM | Report abuse

MosBen,

no i think you have my point. IMO insurers (as compared to other US industries) are highly regulated. To me Democrats want to over-regulate them (many times for political points and not true benefit/value for the consumer where while Republicans don't want to regulate them enough. To me they need to find a workable middle. Too much of the wrong regulation just increases costs. Too little let's overzealous insurers take advantage of consumers.

Posted by: visionbrkr | February 8, 2010 3:31 PM | Report abuse

"2000 - the US budget called for less spending (inlcuding servicing debt) than income from taxes, hence a "surplus.""

"Called for"? As I recall, revenues fell short, and the "called-for" (hoped-for) surplus never materialized. Another deficit year.

It's not a surplus unless you actually deliver the economic growth and revenue necessary to cover the spending.

Posted by: cpurick | February 8, 2010 3:36 PM | Report abuse

"Junk lawsuits" isn't really a comment on the lawsuits themselves. The problem is the shotgun approach an injured patient's attorney takes. The attorney sues every doctor and nurse who signed something in the plaintiff's medical records, no matter how unrelated to the injury. These doctors (or rather, their insurers) end up settling these cases for $5,000-$10,000 apiece, because going to trial would cost $100,000+. By the time the doctor(s) who actually was at fault goes to trial, the attorney has already rung up $100,000 for the injured plaintiff.
Raising the bar for filing suits against these unrelated doctors would probably go a lot further towards reducing premiums than capping the occasional windfall verdict.

Posted by: zspam | February 8, 2010 3:50 PM | Report abuse

Isn't it ironic how repubs love the idea of the free market, then try to jigger the system against an injured person? That's exactly what capping jury verdicts in medmal cases amounts to (as well as exempting gun makers/sellers from civil liability).

It's also a question of equal protection - a doctor who botches an operation doesn't have to worry about exorbitant jury verdicts, so he doesn't necessarily have to be more careful going forward. But if that same doctor causes similar injury to a similar patient by running him over with his SUV while texting his stockbroker and getting serviced by his 'girlfriend', no cap!

Posted by: zspam | February 8, 2010 3:58 PM | Report abuse

Ezra,
In direct comments, your second poster Kevin_Willis second paragraph is the on target, it is not the number of Republican ideas it is the dangerous Democratic ideas that are in the bill that are the problem.

However, two areas that both have got it wrong are regarding "health insurance" and Tort reform. Instead of malpractice lawsuits, there should be "outcome" insurance against untoward outcomes. Many bad outcomes are from poor practice but many more are from poor systems or they just happen in spite of all of the best efforts.

Someone who has a catastrophic outcome has a problem whether or not it was caused by the doctor, system or bad luck. It has become a lottery to see is someone can "win" assistance for a bad outcome. Pulling this whole process away from the legal system is the first step in improving the quality of the medical system. Make it insurance based, remove the Tort lawyers and have the malpractice insurance that doctors pay into cover the patient mishaps. More patients with less money each. The more mishaps a doctor has, the more the premiums. Instead of working to present a legal defense, the doctors would work to ensure the best outcomes, which are often distinct goals, sadly.

Secondly, we need to stop calling health plans "insurance". They stopped being that a long time ago. Catastrophic illness insurance is appropriate and I would be happy to see this as a universal mandate, but stop calling the payment of regular health care as insurance. Insurance covers the rare occurrence by taking a little from everyone. Health Care is not a rare occurrence and the insurance model no longer works, like it did in the 1950s. If we change the vocabulary to one that is appropriate, it is easier to decide what kinds of care are appropriate for the government to fund (like immunizations and their rare side effects) and what is not.

Posted by: JayH2 | February 8, 2010 4:13 PM | Report abuse

I think "What they want is no bill at all"
just about sums up the GOP approach to everything.
Which really makes any attempt at bi-partisanship a 'fool's mission'. One can hope what few reasonable folks who are disgusted at what their party has become and looks like would say enough already-I mean, it made me file a registration change to Independent, but...
Do you think Obama, Ax, Plouffe, et al. are shining a great big old spotlight on their addressing the GOP complaints, Obama sharp as a tack in Baltimore and the SOTU as well as on the non-action of GOP members, so that NO one can miss the efforts of the President or fail to notice how ridiculous and useless the GOP looks? (See SOTU shots.) Then grab tons of clips for election 2010?
How about a shot of those embalmed guys just sitting there at the SOTU with a headline...So, What Have These Guys Done For You Lately??
or The GOP Working Feverishly for Struggling Americans!
What a bunch of stiffs.

Posted by: dcunning1 | February 8, 2010 4:22 PM | Report abuse

Your article conveniently leaves out information and distorts the facts.

1) Tort reform isn't just about lawsuits. It also has to do with the effects on malpractice insurance costs for doctors. Estimating average malpractice insurance at $200,000 a year - the first $100.00 an hour a doctor charges us is to cover insurance.

2) The Democrats insurance proposals do not provide for insurance across state lines.

3) Obama and the Democrats have cut secret deals with the drug companies, insurance companies and doctors and lawyers. The deals were cut, not to save the system or the citizens any money, but to get them to go along with the bill. In other words, the fix is in.

4) Besides all the multi-million payoffs and bribes to the members of Congress, we have heard about, there are dozens of other scams hidden in the back-room bills.

5) The 2700 pages of healthcare reform will not save us any money. In fact, most estimates indicate it will cost us even more than the upward trajectory we are already on.

6) An additional $2.5 trillion dollars for this so-called healthcare reform, to insure and additional 30 million people. And it doesn't even fix the problems.

7) There are a number of existing healthcare plans from around the world, that have some good and some not so good features and results. Washington just completely ignores these. One example that appears to be successful is in Switzerland. However, our Congress could never do something sensible like copy something that has a history of actually working. They prefer to go by their convoluted whims, secret bribes and business-as-usual corruptions instead.

Posted by: jbweb1 | February 8, 2010 4:25 PM | Report abuse

Ezra, Ezra, here you go again with the smoke and mirrors to provide cover for a bill a majority of the country have clearly stated THEY DO NOT WANT! Have you been off on an interplanetary trip thus missing the elections in VA, NJ AND MA? In case you haven't heard in your elitist circles inside the beltway and on Manhattan Island here is some news.

The poor uneducated slobs who have to be told what is best for them by the their betters (Elitists, their government tools & media lackies)what to do ARE IN REVOLT and it includes the independents as well as those ignorant gun and bible carrying hicks WHO VOTE!

Welcome to the US west of the Hudson.

Posted by: PRRWRITER | February 8, 2010 5:02 PM | Report abuse

This is a complete misrepresentation of facts....everything on THIS list was designed purely to get fellow Democrats on board with Obama & Pelosi's radical reform package!!!!

Posted by: FastEddieO007 | February 8, 2010 5:27 PM | Report abuse

If Democrats want to begin to be taken seriously by Republicans, it all starts with lifting the ban that prohibits doctors who participate in government-regulated services to provide OUT-OF-POCKET SERVICES....the current bill bans any doctor providing an OUT-OF-POCKET SERVICE FOR TWO YEARS!!!!

Thus only doctors who make their entire living out of the federal exchange can give your dying grandmother her hip surgery!!!!


NO REPUBLICAN WILL EVER VOTE FOR THIS, AND THESE DAYS MANY DEMOCRATS WON'T EITHER!!!

The biggest FORK IN THE ROAD between you federal healthcare radicals and us in the mainstream middle class opposition is the insistence by OBAMA/PELOSI that any doctors participating in their new federal system be banned from offering out-of-pocket services.

Only doctors who choose to make their entire living out of the new federal system can offer out-of-pocket services.

This means a powerfully connected politician like Barack Obama can buy hip surgery for his dying grandmother if he chooses, but all of us middle class schmucks will be dead-out-of-luck.

THAT IS WHY INDEPENDENTS IN LIBERAL MASS SENT SCOTT BROWN TO DC TO STOP OBAMA & PELOSI!

http://www.bloomberg.com/apps/news?pid=20601070&sid=aGrKbfWkzTqc

Posted by: FastEddieO007 | February 8, 2010 5:28 PM | Report abuse

Thomas Jefferson our 3rd president argued against large goverment in 1804. This is still the point of view were still debaing today in 2010. Federalist-party wanted more goverment control and the Jefferson party(republicans)formed the loyal opposition. Federalist party is long gone and the democratic party now advocates for centralize power.We have benifited and loss for over two hundred years. I think its time to get over opposition for its own sake and take care of our own people

Posted by: nichconklin | February 8, 2010 5:28 PM | Report abuse

The bills in the senate and house follow the rules of Medicare for
private contracting. You can do private contracting but the physician
has to get out of Medicare for two years.
See the link below regarding Medicare and the summary.

http://www.aafp.org/online/en/home/practicemgt/mcareoptions.html

PRIVATE CONTRACTING
Provisions in the Balanced Budget Act of 1997 give physicians and
their Medicare patients the freedom to privately contract to provide
health care services outside the Medicare system. Private contracting
decisions may not be made on a case-by-case or patient-by-patient
basis, however. Once physicians have opted out of Medicare, they
cannot submit claims to Medicare for any of their patients for a two-
year period.
---------
Those in control of Congress do not want to allow private contracting
other than what exists now as evidence by this amendment offered and
defeated in the House:

Here is the amendment that was offered for the House bill but it was
not allowed by the rules committee:
http://rules-republicans.house.gov/ShortTopics/Read.aspx?id=315
Foxx: To make in order and provide the necessary waivers for amendment
#114 offered by Rep. Price (R-GA), which would add language protecting
the private right to contract between individuals and health care
providers.

Defeated

4 to 6*

More on this topic:
http://www.ncpa.org/commentaries/misplaced-criticisms-of-medicare-private-contracting

If Democrats fail to responsibly grapple with rising cost of healthcare BECAUSE THEY INSIST ON THIS UN-AMERICAN IDEA PROHIBITING DOCTORS FROM FREELY CONTRACTING WITH DOCTORS, THE DEMOCRAT PARTY WILL BE DEAD IN NATIONAL POLITICS!

This is not something they can sneak through simply by having a likable smooth-talking President! They will be forever known as the party that insists on inserting the federal government in between every patient and their doctor!


How much un-American can you get?

Posted by: FastEddieO007 | February 8, 2010 5:32 PM | Report abuse

"If people let government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as are the souls of those who live under tyranny."

Thomas Jefferson

Posted by: FastEddieO007 | February 8, 2010 5:34 PM | Report abuse

Tyro, Bush did talk about Social Security reform when he ran. He did not outline the specific language of the legislation. But he ran on addressing the economic sustainability of Social Security. Why some of you insist on mischaracterizing both Social Security Reform (i.e., the language of the legislation) and what happened at the time is mysterious to me. I have no problem noting the Republicans are playing fast and loose with the facts, the language, and are actively campaigning against ideas they once supported. They are not bargaining in good faith, and will do nothing to advance any kind of healthcare reform right now.

While there are certainly differences, the comparison to what the Democrats did in regards to resisting Social Security Reform is similar. And, while I understand that you may not have listened to many of Bush's campaign speeches, the reality is that he mentioned Social Security as one of his key issues several times.

@ Nichconklin: "Jefferson party(republicans)formed the loyal opposition"

Thomas Jefferson did not like associating himself with a party, but the party he was most associated with became known as the Democratic Republicans, which later became the Democrats. The modern Republican party is often called "The Party of Lincoln" because it was formed by radical abolitionists in opposition to entrenched, moneyed Democrats in the South (and some in the North).


Posted by: Kevin_Willis | February 8, 2010 8:25 PM | Report abuse

cantor has said they won't go if the passed bills are the basis for negotiating.

So its crystal clear that the GOP doesn't want to negotiate. Their only power base is obstruction. Its the only thing their 41 votes are good for.

Obama is calling their bluff, and not a moment too soon.

Will the media get it? And even if they do, will they be willing to report it??

Posted by: RalfW | February 8, 2010 8:42 PM | Report abuse

The columnist makes a good point, two thousand pages of legislation has to have something good in it. I say, bring the wooden horse into the city.

Posted by: givenallthings | February 8, 2010 10:55 PM | Report abuse

Let's face facts- neither party has been willing to seriously talk about significantly capping the growth in Medicare costs, which is the real health reform crisis we are dealing with. We need to find a way to pay for what we already have by making it cheaper or at least not buying any of the new overpriced treatments that seem to keep emerging. We can't even pay for what we already have- shouldn't we take care of that first?

We've heard some bits and pieces, like the honest effort from the Democrats to consider end of life issues, means testing, etc., but they are not convincing to me at all, except at convincing me the Republicans are idiots for opposing those terms instead of massive expansion of the subsidies. Still, the Democrats have abjectly failed at making any effort to lower the cost of health care- instead preferring to treat the insurance industry as the villains. They are not directly driving the costs. We keep seeing graphs here of how much is spent per person here, crying about the inefficiency, and propose that giving the same overpriced health care to more people, making those graphs even worse.

We need to move to a system that rewards disruptive innovation, care that costs less, and rewards patients for seeking lower prices. Health care, like higher education, and housing suffers too much from the nearly unconditional government subsidy problem. Health savings accounts, like college savings accounts and those first home savings accounts people used to have before the govt started backing 0% down loans with our future earnings, drive down prices.

If the government can prove it is willing to control costs, willing to make the hard decisions and run the death panels, I am willing to trust it with expanding government subsidized care to more of the uninsured. Until then, it is only going to continue the third party payer system that is putting upward pressure on the costs for all of us.

Posted by: staticvars | February 9, 2010 12:33 AM | Report abuse

Why not just let us in the Northeast and the West opt out and join the Canadian single payer national health care plan?

It would cost us half as much in tax dollars and their software already works with US states, area codes, and zip codes.

WAY CHEAPER.

Why not? You're not afraid of competition - are you?

Posted by: WillSeattle | February 9, 2010 11:59 AM | Report abuse

WoodbridgeVa1: You miss Ezra's point. Democrats are not asking republicans to support democrats' original goals - i.e., single-payer or public option. If republicans were asked to support single-payer or public option, then comparing democrat's reaction to Bush's privatizing social security would have been equivalent to republicans not giving an inch now. But both single-payer or public option were jettisoned with the hope of appeasing republicans and centrist democrats. Indeed, Ezra lists 4-6 core republican ideas already included in the senate bill. Even then republicans are demonizing the bill. Privatizing SS were never democratic ideas, so it was not hypocritical of them to oppose it when Bush proposed it. Republicans' blanket opposition to their own ideas is hypocritical.

Posted by: achena | February 9, 2010 6:22 PM | Report abuse

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