I’m trying not to link to Paul Krugman so much, but when he’s right, he’s right. Republicans’ insistence that the Affordable Care Act will escalate overall costs conveniently neglects to tell you that those costs were escalating at a far faster rate pre-reform anyway. Of course your premiums are going up – they were going to go up anyway. The ‘Pubs made sure that insurance companies would enjoy a fair semblance of business-as-usual – the Dems watered down a lot of justified changes – while unanimously voting against the damn thing anyway.
“…in 1997 Congress enacted a formula to determine Medicare payments to physicians. The formula was, however, flawed; it would lead to payments so low that doctors would stop accepting Medicare patients. Instead of changing the formula, however, Congress has consistently enacted one-year fixes. And Republicans claim that the estimated cost of future fixes, $208 billion over the next 10 years, should be considered a cost of health care reform.
“But the same spending would still be necessary if we were to undo reform.
“…the G.O.P. also claims that $115 billion of other health care spending should be charged to health reform, even though the budget office has tried to explain that most of this spending would have taken place even without reform.”
“The key to understanding the G.O.P. analysis of health reform is that the party’s leaders are not, in fact, opposed to reform because they believe it will increase the deficit. Nor are they opposed because they seriously believe that it will be “job-killing” (which it won’t be). They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do.
“And it’s not about the money. As I tried to explain in my last column, the modern G.O.P. has been taken over by an ideology in which the suffering of the unfortunate isn’t a proper concern of government, and alleviating that suffering at taxpayer expense is immoral, never mind how little it costs.”
Typical conservative thinking about these things is illustrated by this AOL news op-ed, arguing that the reforms may not have even been needed, that the insurance and health care industries were already self-adjusting.
“…national health spending climbed just 4 percent last year. The low number is attributed to the recession, but it actually continues a trend started much earlier.
“…these spending increases would have been lower still had the government kept pace with the private sector. Last year, for example, private insurance spending climbed just 1.3 percent. Medicare spending, in contrast, climbed 7.9 percent. On a per-enrollee basis, private insurance spending has climbed at about half the rate of Medicare since 2005.
“Over the longer term, government health care spending has climbed faster that private spending in eight of the past 10 years.
“At the same time, premium increases have been steadily moderating over the past several years…premiums for employer-sponsored family coverage climbed just 3 percent in 2010, compared with 13 percent in 2002.”
What Mr. Merline fails to consider is that these cost savings came at the expense of the customers they purportedly serve. The ever-expanding list of what constituted a pre-existing condition eliminated thousands from potential payouts. And with thousands of people dropping out of any coverage because it was both ineffective and unaffordable (conservatives never want to talk about the plague of bankruptcies incurred by health care costs shifting to their customers), what industry incomes remained were solely drawn from people who could easily afford it. Costs were only shrinking ‘per-enrollee’ because their overall base of covered customers was shrinking. Sadly, this is the draconian logic behind Paul Ryan’s proposed Medicare voucher system. Rather than paying for services outright, the government would issue vouchers to seniors for them to pay for their medical costs and coverages. But over time, the value of those vouchers would incrementally shrink, putting a larger and larger cost burden on seniors. But as long as the government is spending less and less, That’s OK, right?
“For those currently under 55 – as they become Medicare-eligible – it creates a Medicare payment, initially averaging $11,000, to be used to purchase a Medicare certified plan. The payment is adjusted to reflect medical inflation, and pegged to income, with low-income individuals receiving greater support.”
“The payment is adjusted to reflect’ – not keep up with – ‘medical inflation.’ And ‘pegging to income’ proportions how much help particular income levels are entitled to, but, again, it’s wholly divorced from keeping up with the actual cost of those services.
Insurance companies insist (and not mistakenly) that increasing the risk pools to cover the previously uninsured, and increasing the risk pools to no longer eliminate those with pre-existing conditions, will only work if those pools of insured are as large as possible, spreading the additional costs among as many contributors to the pool as possible, thus requiring the mandate. That’s NOT a Democratic idea, that was the insurance industry’s idea. Otherwise, people won’t pay in to the system when they’re healthy – they’ll only buy insurance when they need it, having contributed little if anything to the pool that they’ll now draw from.
The Republicans (and many others) insist (and not mistakenly) that the government can’t require you to buy a particular good or service from particular private companies. It’s like outlawing the purchase of non-foreign automobiles, or requiring American citizens and businesses to only buy Apple computers. I’m willing to agree this may be a bad precedent, but only if you’re willing to present a reasonable alternative that addresses the problem as well. The Republicans have no intention of figuring this out – the baby goes out with the bathwater because that’s what the founders intended. Ross Douthat doesn’t think that’s a good idea either, and is actually *gasp* suggesting constructive alternatives. My God, does Eric Cantor know about this?!
“…the mandate to buy health insurance infringes on American liberties: never before has Washington required that private citizens purchase a particular product from a particular set of private companies.
“The mandate is a harder puzzle, since it works in tandem with the requirement — popular enough to have many Republican supporters — that insurers cease denying coverage to customers with pre-existing conditions. If you repealed the mandate without repealing that requirement, people could simply wait until they were sick to buy insurance, driving everyone’s prices up.
“But Republicans could propose dealing with the same problem in a less coercive way. One alternative would establish limited enrollment periods (every two years, for instance) when people with pre-existing conditions could buy into the new exchanges without being denied coverage. Anyone who failed to take advantage wouldn’t be able to get coverage for a pre-existing condition until the next enrollment period arrived. This would reduce the incentive to game the system, without directly penalizing Americans who decline to buy insurance.
“But in the unlikely event that the president did embrace a reform of the reform, conservatives would have an opportunity to transform Obamacare from within. With the right changes, the new health care law could expand access to insurance in a more cost-effective, less coercive and more market-oriented way. Which is to say, it could become the kind of reform that conservatives claim to have been looking for all along.”
Douthat, characteristically, poops in his own punchbowl by assuming Obama’s co-operation in improving the existing program is an ‘unlikely event.’ Nonetheless, he sets a fair tone by suggesting we think past partisan boilerplate to actually solve the problems instead of starting from scratch.