Saturday, November 10, 2007

Those Radical Republicans

To hear people talk, you’d think Democrats are more radical health reformers than Republicans. After all, “everybody knows” Democrats want more government power and control with universal coverage based on single payer, and Republicans want the unfettered status quo.

Right? Wrong!

No major Democratic candidate espouses single payer. Instead, they’re pushing more government expansion and universal coverage , not single payer. They’d retain current employer tax breaks. None envision single payer, Canadian or European style. They know that’s not in the American cultural or political DNA,.

The Republicans, on the other hand, want to break from the employer-based system in which not only employers, but everybody else, individuals and the self-employed alike, get tax breaks. Republicans speak od universal fully –refundable federal tax credits, high deductibles, lower premiums, and consumers carefully spending their own tax-free money.

The Democratic approach of retaining the current breaks for employers only, say the Republicans, is deeply flawed for three reasons.

1. Costs rise because employees aren’t paying out of pocket and are shielded from true costs and therefore are careless in how they spend their health care dollars.

2. People lose insurance when they switch jobs and thereby may be chained to jobs they don’t really want or enjoy..

3. Exclusive employer-based coverage keeps millions of individuals from buying insurance because of lack of tax breaks available to individuals and consequent unaffordable high premiums.

Democrats may claim universal tax credits would be reckless because it would cause the current employer-based system to unravel, which it already is. Employer-based coverage has dropped from 69% to 60% of employees covered over the last 5 years or so.

“Our proposals,” i.e, the Democratic proposals, are more incremental, less radical, and less threatening because it keeps things they way they are. The Republicans, Democrats will surely argue, are the true “radicals.” Universal tax breaks would end our current employer-based health system as we know it.

Democrats are right. Republicans are the radicals. Republicans seek to alter the status quo—employers, health plans, and other third parties managing, massaging, monitoring, overseeing, or second guessing patient-physician transactions based on the patient’s perception of the value and worth of the transaction.

That, my friends, is radical. It depends on self-reliance, good information, intelligence, and trust -- qualities in short supply in this partisan world.

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