On the passing of Geroge McGovern---

The 1972 campaign, quixotic as it was, taught me the skills to be a reasonably decent public relations guy, and for that, coupled with the idealism of the age, a bevy of still close friends, and many, many memories make me to grateful to this iconic American leader.

Governor Romney on Health Care

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?