EDITORIAL: Imagine actual health-care reform

July 09--Peter Suderman, an editor at Reason Magazine, wrote an op-ed in the New York Times last week imagining what a Republican health-care plan might look like if Republicans ever got serious about designing one.

Reason defines itself as a Libertarian magazine, so its prescriptions are unlikely to match up well with the goal of universal coverage advocated by many on the left. But Suderman did a good job of describing the cognitive dissonance that makes it almost impossible for Republicans to do anything productive on the subject.

Despite the fact that the Congressional Budget Office projects both their House and Senate plans would reduce the number of Americans with health insurance by something in excess of 20 million, moving the total number of uninsured back toward 50 million, or about where it was before the Affordable Care Act, Republican rhetoric inexplicably criticizes the ACA for leaving too many people uninsured. This looks like nothing more than cynical political pandering, which doesn't help the GOP's credibility with people who have even a glimmer of understanding of health-care policy.

Republicans have repeatedly said they want everyone covered with more affordable insurance plans, even though that's not what their current proposals would do. No wonder that polls show voters overwhelmingly oppose those plans.

It's also no wonder that the prospect of losing insurance coverage frightens many Americans, including those who have shown up at town halls around the country to tell heart-rending stories of families on the edge of ruin because of disease or disability. The soaring cost of medical care puts the vast majority of Americans within one major illness of financial disaster if insurance, Medicare or Medicaid doesn't step in first.

But Suderman does a good job of describing dysfunctional elements of the current system as well. A mish-mash of employer-provided private insurance and government programs for the elderly and poor, the sum of the parts has a Rube Goldberg quality to it. "The result is an unequal system in which health insurance is understood more as a way of prepaying for medical care than as a protection from financial risk," Suderman writes.

"No one starting from scratch would design a system that looks like this."

Even if we can't start from scratch, Suderman proposes that Republicans design a plan as if we could -- using insurance for its original purpose, to protect against financial catastrophe, and finding ways to provide everyday health care more affordably. So many perverse incentives exist in the current system that this would be a daunting undertaking even if politicians were willing and able, but congressional Republicans have shown virtually no interest in even pursuing it.

Their current plans, essentially to reshape the federal budget by taking from the poor to give to the rich, appear purely venal -- doing the bidding of the Republican donor class so it will continue to finance their campaigns.

But Democrats aren't blameless, either. Having been excluded from the secret meetings of a group of Senate Republicans that included Colorado's Cory Gardner, they have been left with no alternative but to oppose the GOP's plan. But too many of them seem unwilling to face the dysfunctional parts of the existing system.

It is easy enough to talk about universal coverage, but even Obamacare didn't get there, in large part because there are not enough incentives for young, healthy people to buy insurance they may not need for years. Similarly, it is easy enough to talk about solving these insurance-related issues by calling for a single-payer system, Medicare for all, without addressing the fact that Medicare and Medicaid are themselves unsustainable at their current rates of spending growth.

This is not a theoretical problem. Entitlements and military spending are fueling a national debt on the verge of passing the $20 trillion mark. Interest on that debt already costs more than $300 billion a year, and that's with interest rates at historically low levels. Passing on such a debt bomb to the next generation is a crime against our own children.

Reforming our health-care system to make universal coverage sustainable would require politicians to take on the massive pharmaceutical and insurance lobbies that help to finance their campaigns. This includes many Democrats, including Colorado's Michael Bennet, who reliably votes with Big Pharma against making it legal to import cheaper drugs from Canada.

So long as Republicans' only plan is to please the Koch brothers by cutting medical benefits for the poor to finance tax cuts for the rich, Democrats have no option but to be in full resistance mode. But if more thoughtful Republicans ever take up Suderman's suggestion to take a serious look at the entire jerry-rigged system, thoughtful Democrats should stand ready to join them.

American workers should not have to depend on their employers for health care. The fact that employer-provided health insurance is not taxed also insulates employees from the true cost of that coverage. And, as Suderman points out, it discourages job switching and entrepreneurship. In the aggregate, the current system offers too much help to people who don't need it and not enough to those who do.

It is no doubt wishful thinking in the current political climate to imagine a bipartisan, constructive effort to reform the existing morass of conflicting incentives. But it's encouraging to see a conservative acknowledging that such a reform is necessary. Liberals, too, will have to take on some sacred cows if they are to help defuse the bomb now awaiting the next generation.

--Dave Krieger, for the editorial board. Email: kriegerd@dailycamera.com. Twitter: @DaveKrieger

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