GOP on Health care: damned commies!

Amazingly, Fed chief Bernake's recent talk before Congress had nothing to do with interest rates or inflation, but instead...health care. Bernake said that access to care for the 47M Americans without it must be a top priority for our country, as well as improving the quality of care and cutting costs. Health care is definitely a bread-and-butter issue for voters this November. As such, there's no better way to sum up the GOP's proposals and responses to Barack's health care plan than this: "Socialism!"

I hope they keep it up. These standard-bearers on the right show you exactly the sort of intellectual rigor and human decency that now characterizes the conservative platform and response to Democratic (not Democrat) policy proposals and arguments. Obama is doing better than that: going to one hour from my hometown, in the heart of Appalachia, to deliver a substantive health care platform speech. The local paper covered the event with a news article and a solid editorial.

Let's look at some statistics in order to get a sense of "what's wrong with healthcare in America":

The Kaiser Family Foundation has a wonderful online tool showing the "fast facts" in slide show format concerning US healthcare. Looking at the number of uninsured in America, totaling 16% of the total population, or 47 M, I found an interesting statistic: 71% of uninsured have a full-time worker in the family and 11% have a part-time worker in the family, meaning that unemployment status can only be blamed in 18% of uninsured cases.

KFF also shows the decline in companies (large and small) offering health care to their workers: from 62% in 1999 to 59% in 2007. If that doesn't sound like much, remember that this is all US companies, so we're talking about literally millions of people losing coverage.

Krugman pointed to new stats on the huge uptick in underinsurance (having inadequate care) among the middle class from a report by the Commonwealth Fund:

The number of underinsured U.S. adults—that is, people who have health coverage that does not adequately protect them from high medical expenses—has risen dramatically, a Commonwealth Fund study finds. As of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 percent from 2003.

Much of this growth comes from the ranks of the middle class. While low-income people remain vulnerable, middle-income families have been hit hardest. For adults with incomes above 200 percent of the federal poverty level (about $40,000 per year for a family), the underinsured rates nearly tripled since 2003.

These results and others are published in How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, (Health Affairs Web Exclusive, June 10, 2008), by The Commonwealth Fund's Cathy Schoen, Sara R. Collins, Jennifer L. Kriss, and Michelle M. Doty.

So this isn't just a question of lower-class income, nor of uninsurance. Underinsurance has to be in the mix as well.

There are four basic models of health care reform: (1) incremental change to existing structures, (2) building on employer-based insurance, (3) consumer-based insurance, (4) single payer.

McCain's plan falls under the third model -- consumer-based insurance, and the Grand Old Party has proposed its favorite panacea to the health care crisis: tax cuts. Unfortunately for those who think this is a solution, reality here has a liberal bias: Robert Laszewski, president of Health Policy and Strategy Associates, LLC (HPSA), analyzes McCain's plan in detail and shows how it comes up far short.

1. People with pre-existing conditions are screwed.
2. A $2500 individual/$5000 family tax credit falls far short of the average $12000 cost of a health care plan.
3. He completely lacks any proposal for "cost containment" and quality improvement
4. Trade associations that's he's proposed would circumvent underwriting laws
5. The young would pay much less and the old much more -- age rating

Robert Kuttner shows in Everything for sale: the virtues and limits of markets that this free market proposal would be undermined by the following false premises:

First, it assumes that competing health plans will take a high road of offering better service, rather than a low road of risk selections and secret financial incentives to participating doctors.
Second, it assumes consumers will have a free choice among competing plans.
Third, it assumes that good plans will drive out the bad ones, rather than vice versa.
Fourth, it assumes that plans will not acquire a degree of monopoly power. And it presumes that consumers will be adequately informed about competing plans.

In short, this summarizes the weakness of McCain's plan.

The Democratic proposals from Barack and Clinton (and Edwards) are a hybrid of (1) and (2), which focus on making affordable insurance available to those without employer-based insurance. The plans do differ on the issue of mandates, an issue where I clearly side with Obama. Barack's plan would prevent the problems associated with McCain's plan in age rating and medical underwriting and pre-existing conditions clauses. In addition, Barack's plan offers a subsidy for low-income families to get insurance coverage that actually makes it affordable for them.

Harold Pollack responds to Krugman about Barack and mandates. His points about the study summarized:

So we're back where we started: two plans, both with guaranteed availability of insurance regardless of health status, both with subsidies. One has a mandate with (as yet undefined) enforcement mechanisms. The other has no mandate but (as yet undefined) financial disincentives for free-riding. Until the two plans are better specified, there is no basis on which to estimate how many people will wind up not buying insurance under either plan, and therefore no basis for any firm estimate of costs to the taxpayer.

This is hardly justification for the holy war the Clinton campaign is waging on Obama on the mandate issue.

David Brooks follows up on the same issue (Clinton's mandates and dealings with health care):

Moreover, the debate Clinton is having with Barack Obama echoes the debate she had with Cooper 15 years ago. The issue, once again, is over whether to use government to coerce people into getting coverage. The Clintonites argue that without coercion, there will be free-riders on the system.

They’ve got a point. But there are serious health care economists on both sides of the issue. And in the heat of battle, Clinton has turned the debate between universal coverage and universal access into a sort of philosophical holy grail, with a party of righteousness and a party of error. She’s imposed Manichaean categories on a technical issue, just as she did a decade and half ago. And she’s done it even though she hasn’t answered legitimate questions about how she would enforce her universal coverage mandate.

Cooper, who, not surprisingly, supports Barack Obama, believes that Clinton hasn’t changed. “Hillary’s approach is so absolutist, draconian and intolerant, it means a replay of 1993.”

Barack Obama has always been against a mandate requiring people to sign up for health care, much to the chagrin of Krugman et al., and last month's American Prospect shows why, by examining a state-level model for the national proposals by Democrats -- Massachusetts:

What's happened since then? While those beneath the poverty level signed up for free insurance in even greater numbers than anticipated, very few people who were required to pay for their own insurance signed up. Even those eligible for partial subsidies were slow to enroll. The deadline to purchase insurance had to be extended, and 60,000 uninsured people were exempted from the mandate because -- yes, that's right -- they couldn't afford it (so much for universality).

And what about enforcement of the mandate? The state has had to push back enforcement, but plans next year to hit individuals with a fine, although they've relaxed the standards required of employers...it's obviously a flawed system. What is the solution? I'd say single payer, model (4) and the model employed by numerous countries around the world.

Agreeing with me would a lot of experts, think tanks and coalitions of health care providers.

If you're more interested in learning about single-payer, check out those links.

In the meanwhile, we have to address a lot of misinformation and elect a lot of progressive politicians.

Check out current and detailed information on politics and health care at Kaiser