An Outrageous Thought: Republican Health Plan More “Progressive” Than Obamacare

Somebody who advocates social, political, or economic reform.

One Dictionary definition of Progressive

What I am about to say will enrage and inflame many “progressives” who equate more government control with “progressivism.” They may even call my words "outrageous," as a defamation and distortion of the progressive movement. If my message provokes and evokes contrary comments, so be it. I invite such comments.

In any event, I will say it anyway. I believe the Republican Choice Act is more “progressive” than the Patient Protection and Affordability Act (PPACA).

The PPACA neither protects nor makes things more affordable.

It does not protect patients against loss of their current health plans. Some 80 to 100 million Americans may have to switch to government-qualified plans before 2014.

It may not be affordable either. Premiums went up 10% in 2010 and are estimated to rise 12% in 2011. After that, who knows? If rising costs and lack of health plan choice constitute being "progressive," Americans seem to saying, "No Thank You!" if the polls are any indication.

The Republican plan – issuing refundable tax credits of $2300 for every individual and $5700 for every family, allowing everybody to shop across state lines for private plans, expanding pretax contributions to health savings accounts to allow patients to salt away more for retirement, offering free preventive services with high deductible plans for major chronic diseases – strikes me as much more “progressive” than the Obama plan.

How so? Well, to begin with, it is much more:

• Universal, i.e., it covers everyone in the private sector and may also be applied in Medicare and Medicaid populations.

• Progressive, in the sense that it gives every citizen roughly the same benefits at their Congressional Representative, Senator, or government employees in a Federal Health Benefit Plan (FEHBP). That's progress.

• Rational, in that it costs $61 billion versus $1 trillion from 2010 to 2020, and $2.3 trillion from 2024.

. Fundable, we can come up with the money to fund without driving the federal budget deeper and deeper into the deficit abyss.

• Equitable , because everyone, individuals and the self-employed, and corporate employees, gets tax deductions. It levels the playing field.

. Understandable, requiring only several hundred rather than 2801 pages to explain, and not needing passage to find out what's in it.

• Patient-centered, because informed patients are given more responsibility for making their own decisions and negotiating with doctors with the knowledge they will be spending more of their own money and in the process becoming more price and value sensitive.

• Predictable, so far experience with Health Savings Accounts indicate HSAs cut premiums and employer expenses by 10% to 20% and cause 30% more employees to buy coverage.

• Less intrusive, no individual or employer mandates, fewer regulations, no forcing of hospitals and doctors into awkward partnerships in into as yet undefined accountable care organizations, no uninvited increases in taxes to the tune of about $550 billion.

• Less of a “big Brother knows best” mentality, requiring the hiring of 16,500 IRS agents to enforce mandates; the formation of 159 new federal agencies, boards, and oversight commissions; and federal experts and analysts, sitting in judgment of the motivations and actions of their fellow citizens.

In my mind, it is “progressive “ to recognize that we are a center-right, individualistic, capitalistic nation that believes in smaller government that relies on the common sense of its citizens as expressed in national, state, and local elections.

I believe in social, political, and economic reform, but only if reform fits the culture and reflects the will of the people.

Richard L. Reece, MD, has posted 1720 blogs at medinnovation blog over the last four years. His main themes are health reform and innovation and how they impact physicians and American culture as a whole. He works closely with the Physicians Foundation but his opinions are his alone. He has written ten books, the latest five are: Sailing the Seven “Cs" of Hospital-Physician Relationships, with James A. Hawkins, 2006; Innovation-Driven Health Care: 34 Concepts for Transformation, 2007; Navigating the Maze of Health Coverage And Access, 2008; Obama, Doctors, and Health Reform; 2009; The Pros and Cons of Accountable Care Organizations, 2011 (an e-book). His new book The Health Reform Maze, will be published by Greenbranch publishers in June 2011. On his blogs, he asks readers to comment . Otherwise, he says, how else can I tell if I making an imprint.