Thursday, September 23, 2010

If the Republicans wanted to be taken seriously

In other news, the Republicans pledge with America is out and it is roughly speaking laughable, at least from a health policy standpoint (haven't looked so closely at the rest). They are trumpeting that they will repeal and replace with something that prevents pre-existing condition exclusions FOR PERSONS ALREADY COVERED. That is already banned in federal law.....that is a meaningless change, and is far less than what PPACA does. Further, it doesn't say what would be included in the way of benefits, or what premium could be charged. In short, this is a phony policy pledge.

If the Republicans wanted to be taken seriously on health policy, they could say something like this, in a face saving manner.

"We thought PPACA wasn't the right way to go [forget about the fact that it was essentially the Republican alternative to the Clinton Plan plus a Medicaid expansion, but I digress]. However, now that PPACA has been passed, we have decided that even though we were opposed to it, we now want to improve upon it. The recent Census report shows how dire the status quo is for our health care system. We applaud the President's commitment to covering uninsured persons with insurance. However, we are very worried about costs. So, we propose the following steps:
  • Medical Malpractice reform. There are many problems with malpractice as I have written, and there are things that could be improved upon. They have proposed med mal reform, but not the items below.
  • Change in the tax treatment of employer paid insurance. They could have said it like this, "The President was on to something in proposing a tax on high cost insurance. However, he lost his nerve as the tax was delayed in the reconciliation bill until 2018. But, the original tax on high cost insurance is still in the Senate bill, and being updated by 1 point above CPI annually. That means that in 10 years when the reconciliation provisions run out, the tax on high cost insurance will likely apply to two-thirds of policies. We propose a more straightforward capping of the tax exclusion of employer paid insurance. It is time to level with the American people--they are the ones getting the tax expenditure benefit from this aspect of the tax code, and reducing it will definitely slow health care cost inflation. The President demagogued the issue by calling it a tax on insurance companies when everyone knows that the tax on insurance companies will be passed on to consumers in any event. We therefore propose capping the tax exclusion (how much premiums paid by employers that is tax free) at the national mean for insurance premiums (around $14,500 for families).
  • Finally, we are certain that the baby boomers do not want to leave their children with debt to pay for their basic needs, such as health care. Given that PPACA has developed a sliding income premium support for health insurance staring in 2014, we suggest raising the Medicare age to 67 by 2025. This would mean that persons who turn 65 in Jan 1, 2014 will now be eligible for Medicare on March 1, 2014, and so on.
The above would reduce the deficit by around $600 Billion over 10 years or so (most of it not coming from the med mal provisions). If the Republicans staked out positions like these, then they could plausibly claim that they were serious about reducing health care costs.

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