GOP on Healthcare…

One of the GOP’s main talking points this election season is repealing Obamacare. The real point of that is to keep Obamacare at the fore since the American public is still unconvinced that it is a good thing. In general, I agree that Obamacare is not a viable, long term solution in its current form. One way or another, I think the Affordable Care Act (ACA) will morph into something else. However, I do not think the GOP will be successful in repealing the ACA and if they are successful I do not think the action would be popular.

I am a life long registered GOP voter. I do not always agree with the party but it most closely represents my political views. If the GOP is serious about repealing ACA they first need to explain what they will replace it with. What does the GOP healthcare reform look like? The DNC did a good job of squelching GOP proposals and even GOP participation in the healthcare debate during the 2008 – 2010 time frame when ACA was developed and finally passed. I think most voters believe that the GOP had no alternatives proposals. This is untrue. The GOP was making proposals, they just weren’t very effective at getting their story out, which is a long standing problem for the GOP.

The proposal I still prefer had three main components; decouple healthcare from employers, allow insurance providers to operate at the national level instead of the state level, implement meaningful tort reform. To this I would add one more important component; an assigned risk pool for those deemed un-insurable.

Insofar as I can determine health insurance as an employment benefit started during World War II when wage caps prevented employers from offering ever higher wages. Health insurance coverage became allowed as a form of compensation to attract workers. Today, health care coverage being attached to one’s employer makes no logical sense. Moreover, the arrangement skews the market in a direction that puts the individual at a disadvantage.

Because health insurance is currently obtained primarily through one’s employer, heath insurance companies spend the bulk of their effort developing products aimed at winning medium and large companies because this is where the biggest profit is made. Health insurance products for individuals and small companies require significantly more effort to sell and offer a significantly smaller profit margin.

Decoupling health insurance from employment is simply a matter of taxing health insurance contributions made by the employer as income to the individual. This will force health insurance providers to focus on developing products for and selling to individuals rather than corporations. The individual consumer gains direct control over their health care options rather than being forced to choose from whatever list of options their current employer decided to provide. The health care provider is motivated to develop better products for the individual and family because this becomes their primary means of delivering their product.

Removing state boundaries allowing health insurance companies to operate nationwide greatly broadens the pool of insured. All but the smallest health insurance companies already operate nation wide. Eliminating the state boundary requirements would simply allow them to do so more efficiently. Some states would benefit from increased competition.

Tort reform would be a real attempt to reduce health care costs. Much of the increasing cost in health care is related to minimizing exposure to malpractice suits, either through higher malpractice coverage or by ordering a myriad of tests primarily for the purpose of protecting the practice against law suits. Tort reform would very probably also be the most difficult piece of the proposal. Tort lawyers are politically well organized, well funded, and very active in lobbying.

The component not on the GOP proposal but which I think is critical is an assigned risk pool. In my mind, this would work similar to auto insurance assigned risk. Individuals who have medical conditions that warrant it are put in the assigned risk pool. In the case of auto insurance assigned risk carries a high cost as a penalty for being a bad driver. Since medical conditions seldom if ever warrant punitive measures, assigned risk health insurance could work exactly the opposite. Anyone in assigned risk would get health care coverage at the same price as a healthy individual with no medical issues. The assigned risk pool would be evenly distributed across all health insurance companies and participation is required. The government could help subsidize this group thereby using tax dollars to help those who need help.

I understand that people do not like ACA but let us get passed the emotional desire to punish anyone and focus on making a better health care system in this country. If the issue is providing top quality health care to as many citizens as possible, let us focus on that. Not on whose plan we are using or who gets the credit or the blame.

The GOP could implement each of these components without the drama and backlash of repealing ACA. Either as a package or as individual items. The GOP could bill it as their contribution to improving ACA which would go to demonstrating their willingness to find common ground and cooperate.

How does the GOP plan to solve the problems that ACA is attempting to solve? I understand that the GOP does not think ACA is a good solution. I even agree that it is not a good solution. However, ACA has made things better for my family. My son, who has a pre-existing condition and cannot get health care coverage on his own, benefits from ACA. The GOP should focus on convincing American voters that it can make health care in America better. Better than it is now, better than what ACA is offering. The GOP tells me they want to repeal ACA but they are silent when I ask what they plan to replace it with.

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