Romney
comments on his version of health reform in last week’s New England Journal of
Medicine.
http://www.nejm.org/doi/full/10.1056/NEJMp1211516?query=TOC. Physicians must be disappointed he’s so
facile, like he’s talking to an American Legion post.
Lots
has been written generally about the Romney-Ryan jihad against the Affordable
Care Act, but what is offered in its stead?
A lot, actually, if you visit the Romney website (http://www.mittromney.com/issues/health-care). The problem is, most of his proposals nip
around the edges of what’s needed in health care reform, and only offer decades-old Republican
chestnuts that will not cut costs and do nothing to lend a hand to the millions
of Americans, around 47 million it seems, that do not have access to health
plans.
Here’s
what in the Romney toolkit, with, of
course, comments by moi.
•
Block grant Medicaid and other payments to states—
Block grants surely mean rationing. I thought Republicans hated
that.
•
Limit federal standards and requirements on both private insurance and
Medicaid coverage—
Doesn’t this mean “race to the bottom?”
If the government does not establish standards, insurance
companies
are free to establish restrictive policies and coverage that wouldn’t include
Band-Aids.
•
Ensure flexibility to help the uninsured, including public-private
partnerships, exchanges, and subsidies
To date exchanges haven’t
been very successful where they have been tried. Just what do they have in mind when they talk
about public-private partnerships?
Would these be any cheaper and more effective than the current system?
•
Ensure flexibility to help the chronically ill, including high-risk
pools, reinsurance, and risk adjustment
Guys, it’s pretty well
established that high-risk pools have not worked. One can participate, but the costs are
extraordinary. How is this helpful?
•
Offer innovation grants to explore non-litigation alternatives to
dispute resolution
Who is this helping? Certainly not patients. But fine, let’s see the meat on the bones of
this old GOP principle.
•
Cap non-economic damages in medical malpractice lawsuits
Same as above.
•
Empower individuals and small businesses to form purchasing pools
This actually isn’t a bad
idea. There’s no reason organizations
cannot do this now. What Romney needs to
do, however, is demonstrate how he’d be willing to actually encourage purchasing
pools. And what they’d cost.
•
Prevent discrimination against individuals with pre-existing conditions
who maintain continuous coverage
Well, duh. This is one of the central goals of the
ACA. Glad to know the Reps are on
board. The problem of course, is that
if the ACA is repealed, Congress would be glaceriously slow in adding a benefit
such as this to whatever bill they try to replace the ACA with. It may be years before this common-sense
provision is restored. Further, the
good governor means to cover people who have previously enjoyed insurance. If you haven’t for a time, tough luck.
•
Facilitate IT interoperability.
Sure. Why not?
Everyone in on board with this.
•
End tax discrimination against the individual purchase of insurance
I drink to this. But would the COST of such coverage be
unavoidably high?
•
Allow consumers to purchase insurance across state lines
What is it about state
lines that enamors the GOP? Will it
mean that insurance companies will relocate to states with the least
restrictive laws for them?
•
Unshackle HSAs by allowing funds to be used for insurance premiums
I thought we weren’t going
to talk about “shackles” anymore? In
any event, how does this save money for the consumer and the health care
system?
•
Promote "co-insurance" products
Okay, I give up. What are these?
•
Promote alternatives to "fee for service"
Fine and dandy. But the ACA makes very specific recommendations
in its 2,000 pages about how this is to be accomplished. Is Romney going to throw out what’s already
in place, replacing it with who-knows-what?
·
Encourage "Consumer Reports"-type ratings of alternative
insurance plans
Why not rating all health plans.
Oh, doesn’t Consumer Reports and other organizations already do this?
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