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.
