Today Katherine Kersten, a conservative columnist for the Minneapolis StarTribune, offered her recommendations on how to achieve a bipartisan healthcare bill.
There were a number of problems, which I'll go into further, but the most significant simply was this, her solution was for the Democrats to become Republicans, and simply adopt all of the Republican ideas while abandoning ALL of their own. In short, her bipartisanship was simply, "We can be bipartisan if you do what the Republicans want, and expect no comprimise from us." That's not bipartisan, that's capitulation, and it's silly to think the majority party should simply acquiesce on all points and call it bipartisan. It is anything BUT BIpartisan, it is purely partisan.
She made several points - which I'll discuss below:
1. Her first suggestion was to allow for insurance carriers to compete across state lines. The idea is to foster competition by allowing carriers who are succesful in one state to compete against those in other states who are 'less incented' to be price competitive. This sounds good on paper, but it is anything but correct. First of all, virtually ALL carriers already compete in many states, if not all. There isn't some 'hole-in-the-wall' state where only small carriers are keeping rates jacked up due to a lack of competition. In fact, in Minnesota, the law stipulates that health carriers MUST be non-profit, a fact that chased several carriers OUT, not into the state, they could not compete with programs priced at a non-profit level (or rather would not). But the more significant element is the concept of state rule, each state has passed laws protecting consumers from various predatory practices. Most states are pretty aggressive in this, a few, like Delawaree, instead prefer to offer safe haven to insurance carriers who chose to offer less than robust coverage. When these states did this, states enacted laws with provisions referred to as 'extra-territorial' or 'extra-territoriality' clauses, these clauses required that if the majority of a health plan group resides in the state, even if the company is headquartered elsewhere, the laws of the state prevail. The fact is that any carrier can offer a group program to employees across state lines if the group represents employees from several states, but they are required to conform to the laws of those states. This recommendation does NOT seek to offer competition, instead it seeks to eliminate those extra-territorial clauses and requirements. It will strip away MANY MANY protections of consumers, and subject them to coverage by carriers who incorporate in Delaware, and thus where none of the normal kinds of provisions will exist. Laws prohibiting predatory coordination of benefits, or predatory re-pricing into new groups, will be gone. This is a sop to business, and nothing more.
2. Ms. Kersten suggests that small businesses should be allowed to 'pool' into larger group programs, like large companies can do. It's a reasonable idea, but as a news flash to Ms. Kersten, THEY ALREADY CAN. Most states have group consortiums, and even where they don't, any number of small employers can form a benevolent association and buy larger group insurance. We don't need laws for it. That said, this is the same concept, of a large, sweeping program, that Ms. Kersten objects to about Obama's proposal, which smacks a little of either hypocrisy, or an unreasonable fear of the government - an unfounded fear at that since Medicare works VERY VERY well.
3. Ms. Kersten also suggests allowing for health savings programs in greater measure, but these are already present, and in growing numbers, yet have never proven to be the panacea that the right used to very frequently suggest it would be. Catastrophic, high-dollar deductible .. whatever you call it, making the consumer bear some of the pain is very much the way to reign in some of the inflation in the system, but it cannot be done overnight, or it would cause massive deflation, a catastrophe of unfathomable proportions, in 1/6th of the economy. Further, it doesn't address the increasing age of the population - which is the KEY driving element of health care inflation.
4. Finally, Ms. Kersten brings up malpractice, and tort-reform. She suggests that 100 Billion dollars annually is spent on unnecessary medicine to avoid charges of malpractice. My response is, such a suggestion is ludicrous in it's face. Their is a GREAT deal of overutilization, but Medicare experts suggest it is VASTLY more about fraud than defensive medicine, and further, there are MANY MANY other reasons for defensive medicine than simply avoiding a malpractice charge, not the least among them, ensuring you haven't missed something. Further, malpractice costs have been tied FAR FAR FAR more to losses suffered by malpractice carriers who invested premiums in the stock market, and so looked to recoup those losses by jacking rates, than due to frivolous lawsuits. Finally, frivolous lawsuits don't get awards above $250,000 very often (read damneed near never). Malpractice carriers may be willing to shell out $5-$15k as nuicance payments, but they absolutely AREN'T willing to pay 1/4 of a million. If the case has no merits, it is MUCH less costly to contest it in court, since, if it is frivilous, it is easy to dispense with. NO, instead, what THIS tort reform cry is about is protecting malpractice carriers from paying for claims and losses in exactly the kinds of cases they are SUPPOSED TO PAY, namely, where a doctor really and truly screws up, usually negligently. 100,000 people die each year in hospitals or other clinical environments due to mistakes, most of them innocent, but still mistakes about countra-indicated mixing of medicines. MANY thousands die from negligent conduct, and doctors buy malpractice because the cost of paying families for these negligent mistakes is FAR more than just a few thousand dollars. If they had to pay out of their pockets, as would EVERY OTHER TYPE OF BUSINESS which didn't have similar liability insurance, it would bankrupt them, but it would rightly, THEY cost someone their life or limb. This is instead about making doctors sacrosanct from their mistakes, limiting awards to an amount they could probably pay out of their pockets. Malpractice insurance would be a nuicance element - but you should not expect, not for one moment, that costs would be materially affected. Malpractice costs are estimated to comprise about 1/2 of one percent of the inflationary pressure in the market. Defensive medicine is certainly another driving factor for costs, but fraud as well as proper thoroughness are part of that factor as well, and I have heard estimates that there is no less than $40 Billion in fraud in defensive medicine, so Ms. Kersten's numbers, which were not attributed, likely are VASTLY inflated.
In the end, the Republican proposals either are to do little (propose HSA's or group coverage for small employers) including proposing things which are already in place, or they are to provide bail-outs for insurance carriers (in malpractice) or to propose changes in law which will allow for predatory trade practices as carriers flee to havens where protective laws are not possible to enforce. That's not change, it surely isn't standing up for the common man, and one other thing it isn't, it isn't bipartisan, not by a darned sight. It is simply asking the people to let the corporate interests determine the best way forward, and as recent history has shown with respect to wages, with respect to banking, and with respect to jobs, that may be good for the wealthy corporate leaders, but it is anything but good for the rest of us. Ms. Kersten's ideas are both staid (they are ideas which have been around and tried for the better part of 20 years), and decidedly partisan.