Thursday, January 20, 2011


What's next in the health care saga?

I believe that at least a few Republicans are sane, intelligent, and compassionate.  Providing affordable health care to all Americans is a noble and compassionate goal and I believe that at least a few Republicans share it.  I believe that these compassionate Republicans who voted to repeal the existing health care law would replace it with something that would achieve the goal of universal health care.  Let me try to argue their point.

First, these compassionate Republicans believe that health care should continue to be paid for by private insurance.  They oppose a universal single-payer plan such as the one in Canada or the national health insurance such as the one in Britain.  They favor making it possible for everyone to buy private insurance.  That implies that the insurance premiums have to be affordable.  How does one achieve that goal?

You can not achieve it by simply legislating the size of the premiums.  Private insurance companies have to earn a profit.  They must set premiums high enough to cover the cost of the money they pay to medical providers.  The whole idea is shared risk.  The average person is healthy and does not need any expensive medical treatment.  A few individuals do need expensive treatments.  The cost has to be shared among both groups.  That is, it is necessary that every person has insurance and pays premiums.  The same principle applies to home insurance and auto insurance.  Everyone pays premiums but few collect benefits.

OK.  Compassionate Republican principle number one is that everyone must buy health insurance.

Perversely, one of the big Republican arguments against the existing health care plan is the universal mandate.

A corollary of the principal of requiring everyone to buy health insurance is that insurance companies must not be allowed to cherry-pick their clients.  A health insurance company must sell a policy to anyone who applies, regardless of the risk that person poses.  The company must ignore any preexisting conditions in setting the premium.  Otherwise those persons who need insurance the most will be faced with impossibly high premiums to obtain it.

A second belief of compassionate Republicans is that any move toward universal health care should use, as much as possible, existing systems of providing and paying for medical care.  The existing system relies on insurance companies that are regulated by State Insurance Commissioners.  Different States have different rules and limits regarding premiums, determining what medical costs are covered, and the like.  The result is that a person buying health insurance is limited to those insurance companies subject to the regulation by the State in which they live.  A resident of California shouldn't buy insurance from a company that is regulated only by the State of Nevada, for example.

It has been proposed, in the name of competition, to allow insurance companies to sell policies in any State, particularly in States in which they are not regulated.  If that change were to be adopted it would require that the federal government set up a national insurance commissioner to replace the 50 State insurance commissioners who now regulate the insurance industry.  Alternatively, the insurance industry would operate without any regulation at all.  Neither alternative seems to be one that truly conservative Republicans would embrace.

Perversely, some Republicans have advocated just such a change.

My conclusion is that the thoughtful and compassionate Republicans are not the ones that set Party policy.  The policy of the Republican Party seems to be simply to oppose anything that Democratic President Obama advocates.  I join in calling it "the party of NO."

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