Josh Marshall has a short, but insightful, piece up that gets to the core of the GOP’s approach to health care:
Piece through the rhetoric [of this opinion column by Reps. Shadegg and Hoekstra (R) in the Wall Street Journal] and the essential message is true to what the Republican leadership believes about health care and health insurance policy.
In short, the problem isn’t that your insurance costs too much or that you might lose it or anything like that. The problem is that you have insurance, especially insurance through your employer. Ideally you wouldn’t have insurance at all or at least you’d have much less of it.
That can’t possibly be true, right? Just a bit of partisan rhetorical excess, surely. But it squares pretty well with what I’ve heard from “conservatives” (at least the ones that aren’t busy bleating about socialism and indoctrination). Consider Marshall’s example:
The problem is that you go to the doctor and agree to take the tests the doctor recommends. Shadegg and Hoekstra want a system where if your doctor suggests a biopsy for a suspicious lump you think about the pros and cons. Is it worth the money? Do you have the money? How suspicious is the lump anyway?
[ . . . ]
This is the essence of the Republican plan: the fact that you’re insured and aren’t directly feeling the cost of individual tests and procedures is the problem and getting rid of the insurance concept is the solution.
Marshall then boils it down:
To be clear, such an approach probably would cut costs because most people just couldn’t afford to get a lot of care, which is a great way of cutting costs. But remember, the problem according to most Republicans in Congress isn’t that there’s not enough insurance or that it’s not good enough. It’s that there’s too much. The problem is that you have insurance. And good policy will take it away from you.
I think that’s a pretty fair description. Sure, I may draw an objection, where someone claims that free-market fairy dust will be spread across the industry, and that this will create competition that brings down prices. But that’s a fantasy (along the same failed lines as HSAs).  The medical services industry isn’t in the business of competition, and individuals don’t approach their health care needs as they do commodities. Health care is an essential service, and doesn’t really work all that well with imaginary free market parlor tricks.
LFS
Wow. One illogical leap to another and you just keep drinking the cool-aid.
Exactly how does giving people more choices to purchase health care insurance equate to less insurance coverage? Exactly how does letting people have more say in the health care they receive mean less coverage?
MB
It’s “kool-aid”, LFS. Stay in school.
The goal is securing the health care you need, right? “Choices” to buy products that don’t deliver that care are meaningless. The smoke and mirrors about choices plays well, but it’s often just cover for more bad policy. I mean, if you’re really into “choice” for its own sake, I suppose you could take up a campaign to legalize selling yourself into slavery. Let me know how that goes. Or don’t.
Paradox13VA
Except there aren’t really “choices” in most places. Most places are dominated by a handful of insurance companies who don’t really “compete” so much as take orders.
http://www.openleft.com/diary/14744/death-panels-vs-the-herfindahlhirschman-index
Thanks for blogging this important article.
MB
You know, I don’t think I ever expected to see someone drop the term “Herfindahl-Hirschman Index” into my comments . . .
(In fact, I was thinking about it just the other day, when I read about (what looks to me like) price fixing by the big Am beer companies – http://www.latimes.com/business/la-fi-beer26-2009aug26,0,1550813.story)
LFS
Sorry MB. I’m not as familiar with the practice of poisoning congregants as you are.
But it sounds like the argument here is that choice is bad because we don’t have choice. What kind of argument is that (I mean, other than self-referential)? Yeah, there are many places where there isn’t much choice. That’s because the Democrats don’t want to allow more choices by allowing insurance companies to sell across state lines, etc… So if you’ve got an issue with there not being many choices for health care insurance, quit squawking at the GOP and get your side to do something about it.
Regarding your smoke and mirrors statement, I’d like to see your evidence backing up that assertion. Or have you just placed yourself as the arbiter for the satisfaction others have when making purchasing decisions? Because if you believe that most people like being told how to spend their own money, you are highly uninformed. And to segue into your asinine slavery statement, why don’t you let me dictate how you spend your money and then tell me how you feel about it.
Amit
its pretty simple to me. make healthcare costs tax deductible to the individual and let the competition (similar to what Obama said in his speech today) drive down costs and increase quality.
tx2vadem
Well, you could create a system of standardized coverage plans like term life insurance. Then if you had national insurance exchanges, that would provide price transparency. And that, in theory, should drive down premium costs. But the insurance companies would also need to be able to deny claims and drop coverage. If not, then premiums would remain mostly unchanged. Alternately, they would have to make individuals pick up more of the cost. That would again in theory make people more involved in their health care decisions. However, the health care system as a whole is still for-profit; so, the participants don’t have an incentive to reduce the amount of service they provide and really lower the overall health care bill of the country. That’s the real barrier to cost reduction in aggregate and at an individual level. The system is designed to produce greater profits; that’s why they hire all those MBAs to run hospitals.
To Amit, opening up something to competition doesn’t necessarily produce competition. You need only look to Virginia’s own Electric Utility Restructuring Act that was intended to create a competitive electric market in Virginia (incidentally, the same bill that Bob McDonnell now brags he undid through his push for re-regulation.)
Amit
tx2vadem, not sure if the utilities are a fair comparison here because there are few enough players where they can still collude with each other. I don’t think you would argue that competition in most industries forces greedy companies to lower costs and provide more choices.
tx2vadem
I think the Restructuring Act is a good example. What was the incentive for AEP, Dominion, PEPCO, Mirant, Constellation and others to collude? Look at the PJM members list. All of these companies (incidentally a lot of folks, not a few) got together to ensure that Dominion kept all of its customers in its service territories? Collusion is not the reason that the law failed. And if collusion is your concern, insurance companies have an anti-trust exemption. That is part of why they mirror utilities and utilities provide an excellent example.
I don’t dispute your point about cost, that was my first paragraph. It depends on a lot of variables as to whether individual consumers receive the benefit of a cost reduction though. And what incentive is there for the system to reduce cost? Expanding on your point, greedy health care providers who are reimbursed per service provided have the incentive to provide more service (regardless of necessity) and submit more claims. Unless you want insurers to instruct doctors/providers on procedures (better them than government bureaucrats, right? =) ). But I thought we just went through this big backlash in the 90s where we didn’t want insurers to deny anything or tell doctors what to do. Why are insurance companies not serving as a brake on exponential cost growth now? And how is a competitive insurance market going to solve that?
LFS
tv2vadem wrote: “However, the health care system as a whole is still for-profit; so, the participants don’t have an incentive to reduce the amount of service they provide and really lower the overall health care bill of the country.”
What? Are the “participants” the insurance companies or the consumers. Either way, that doesn’t make a lot of sense. Insurers do have incentive to reduce medical costs. And consumers don’t want to see their rates go up or pay co-pays.