Saturday, December 17, 2011

GOP Issues Part One: Healthcare

Article first published as GOP Issues Part One: Healthcare
 
on Blogcritics.


Health care will likely be a contentious issue far beyond 2012, as continued increases in medical care and pharmaceuticals abound, and insurance and Medicare/Medicaid costs continue to rise.  The solution to this problem is far from simple, and will have to include changes to all of the various aspects to be acceptable the American people.


For reference, here is the summary of “The Patient Protection and Affordable Care Act”, useful since it is the focus of most of the candidate’s health care platforms.  This site has an overview of the candidate’s stances on health care, although its neutrality may be in question.  Below I will define my understanding of the positions of each GOP candidate with regard to health care, Medicare, and Medicaid, and provide links to interesting sites.  The mini-profiles are in alphabetical order – no bias is implied or intended.

Michele Bachmann claims to have the longest business career having started at age 5 (see quote here), but that’s not really pertinent to the issues.  She has been rather staunch in her opposition to “Obamacare”, claiming that both the Gingrich and Romney plans are too close to the President’s plan.  She seems fuzzy on the cost of the President’s plan; although the author of this article may not have realized that it could have been hyperbole, or not.  Her proposed H.R. 502, Health Care Freedom of Choice Act, would: make premiums 100% deductible, expand HAS/FSA, and allowances for small businesses to band together for better insurance rates.  This plan and other topics are discussed on her house.gov page.

If we consider Romney to be a flip-flopper, then Newt Gingrich must look like a Mexican Jumping Bean.  His history of support for a federally mandated plan goes back, at least, to 2005 when he partnered with Hillary Clinton on a bi-partisan reform plan, and by 2008 he said that it was, “fundamentally immoral for a person to go without coverage, show up at an emergency room and demand care.”  In his 2005 book “Winning the Future”, Newt said, "You have the right to be part of the lowest-cost insurance pool and you have a responsibility to buy insurance. …a 21st Century Intelligent System requires everyone to participate in the insurance system."  Gingrich claims that during his term as Speaker, that major reforms then “saved Medicare from bankruptcy”, but they apparently did not do the job right.  When the House voted on the Ryan plan earlier this year all but four Republicans voted in favor of passing it, but Newt called this “right-wing social engineering” and denounced it, but at other times he has endorsed at least parts of this plan.

Jon Huntsman Jr. is against having any form of mandated coverage now, in Utah anyway, but apparently did support one in 2007 as part of a United Way plan.  At that time he said, “I wouldn't shy away from mandates. I think if you're going to get it done and get it done right, a mandate has to be part of it in some way, shape, or form.”, especially as pertains to children as noted in this link.  Depending on which way he is currently flopped, he wants states to experiment and find the best solution, except probably Utah.  Another area in which he differs from the others is in a plan to streamline the FDA to lower drug-to-market costs, which he seems to be working on with the UCSF Chancellor.  Here is a little more about his plan, although light on detail, does give some of his thoughts.

The fact that the U.S. Constitution does notmention Medicare is not lost on Ron Paul, although the comment about general welfare could pertain (or was that the Declaration?).  At any rate, he is against federal meddling in state affairs, such as with healthcare.  Ron partly blames “government enforced monopolies” (HMOs and Pharmaceutical companies) for much of the problem, followed by the FDA.  In his opinion the only solution is to let the free market competition select the best providers.  It could be, that as a doctor, he has better insight into this problem that other candidates, but he was an OB-GYN, does that count?  Here are some questions answered by Ron, as well as some of his voting record on healthcare.

Rick Perry is firm on his stance against the Affordable Care Act, but apparently all for a bi-national plan between the U.S. (or just Texas: did they secede?) and Mexico.  It also seems that Rick used the same doctrine of “social costs” to justify his HPV vaccine scheme in Texas, as President Obama used for his health plan: which by the way, it would have been mandated for all girls.  In trying to understand his broad scope for reform, there is not much to go on: state controls over the FDA and Medicaid, but no details.  If we rely on his gubernatorial record then we might expect low spending on mental health and fewer Americans covered by insurance than the national average.  Rick is being a bit hypocritical since Texas is already reaping the benefits of “Obamacare” to the tune of $12 billion just for Medicaid.

It is claimed by many that Mitt Romney has flip-flopped on his healthcare stance, vilifying “Obamacare” while promoting the virtues of his, remarkably similar, Massachusetts plan, which in turn echoes a 1974 plan promoted by Nixon.  According to a PolitiFact article this is mostly false, saying that the primary difference is that while Romney is in favor of individually mandated care, it is to be managed at the state level as opposed to at the federal level.  It has been said that Mitt is in favor of a modified Ryan/Wyden plan, but has not specified what changes he would endorse (or it could be that the R/W plan has been copied from Mitt’s).  The basics of this plan are to leave the benefits for current seniors (over age 55 now) and give younger beneficiaries a fixed amount per year to be spent using a selection of private insurance options.

Rick Santorum backs his statement that it’s okay for insurers to deny coverage for pre-existing conditions; he has a daughter with such a condition and he pays a premium for that.  In this article he makes an analogy between health and auto insurance.  Rick sees insurance as a backstop for major illness, and believes that HSAa should be the future of health care.  He has remained firm in his conviction that individuals, not the government and especially not the insurance companies, should be responsible for their own health care.  He has flip-flopped on Medicare, supporting it (at least Part D) before becoming critical of it during his campaign; although he does support the Ryan plan.

I believe that the levels of waste, fraud, and abuse to these interconnected systems must be the first attack point, followed by a comprehensive policy change.  How can we know which plan makes the most sense without understanding where the current plans are broken?

Current estimates of fraud in the Medicare system is, conservatively set at, $87 billion for 2011, but is possibly three times that much.  These are the documented fraud cases which range from a Brooklyn dentist claiming 1,000 patients in one day, to a high-school dropout that filed $105 million in bogus claims, to an approximate $27 million paid to dead people.  The abuse of the system also includes giant pharmaceutical companies that over-estimate the “sticker price” of drugs so that they can charge Medicaid more, and doctors and healthcare providers “bilking” the system for treatment over-charges.

Even if we can’t understand now what the real extent of the problem is, saving $87 billion a year could go a long way towards lowering the deficit.  The GAO has published more than 158 reports on Medicare/Medicaid fraud since 1986, with similar reports coming from the HHS, inspector general, and other agencies, resulting in hundreds of statute and regulation changes with seemingly little effect.  Disturbingly, most of the high-profile cases are found not by the enormously expensive federal fraud programs, but by tenacious reporters poring through Medicare/Medicaid records.

At least one of the candidates, Rick Santorum, was quoted as saying that lack of health insurance did not cause any American deaths.  This could be strictly true, but this study tells a different story, estimating some 45,000 deaths per year.  Considering that almost 60 million U.S. citizens are living and working without healthinsurance, which comes to about 0.0075%, this seems feasible, although not everyone agrees as this article states.  Given the astronomical costs of a major illness, surgery, or extended therapy, it seems reckless to live uninsured; but for those at, or below the poverty line there aren’t many choices.

The republican stance on health care is that without complete repeal of “Obamacare” the economy will finish its collapse.  On the other hand, the Democrats say that more people will sicken and die without government managed care.  Surely there is a reasonable middle ground where the American public can meet.









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