The effort by the state, by the government, ought to be to try to create catastrophic coverage, where there is relief for families in our country, where if you have a hardship that goes way beyond your means of paying for it, the government is there or an entity is there to help you deal with that. The rest of it ought to be shifted back where individuals are empowered to make more decisions themselves.
This is how assumptive 2016 Republican Presidential candidate, Jeb Bush, summarized his replacement for Obamacare.
While we don’t have all of the details, there is a lot to parse in this particular statement.
At first blush, the discussion of catastrophic coverage is at the heart of the Republican message.
Bush advocates replacing the ACA “with a model that is consumer-directed, where consumers, where patients, have more choices … where the subsidies, if there were to be subsidies, are state administered … where people have more customized types of insurance based on their needs; and it’s more consumer-directed so that they’re more engaged in their decision making, and they have more choices than what they have today.”
This was the same message the Romney presented when asked about healthcare for the poor during the 2012 campaign.
Well, we do provide care for people who don’t have insurance. If someone has a heart attack, they don’t sit in their apartment and — and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.
That is the healthcare system that we had. One where those who couldn’t afford insurance could receive the most expensive form of care our healthcare system had to offer. Those that attempted to pay those bills often ended up bankrupting themselves. Most of those bills were passed on to those with insurance through higher hospital costs.
Catastrophic coverage as envisioned by Mr. Bush is just one step away from this model. The stated goals are to make insurance more affordable by introducing high deductibles and cost sharing. In the minds of conservatives, this makes people more thrifty healthcare consumers, since much of the cost of everyday care is coming out of their pockets. The reality is that high deductible plans in many cases are not much different from no coverage at all. They discourage people from seeking preventative care.
While high deductible plans may flow some additional dollars into the hands of hospitals for the expensive emergency room visits that will result from failure to employ preventative care, it will not mitigate the financial risk of those who have a medical emergency. That’s because, as this graph shows, fewer than half of those who are likely to purchase these plans have the money to pay the deductible if in fact they DO experience a medical emergency that their plan covers.
The second problem in Bush’s unraveling of Obamacare is wrapped in the clothing of “more customized types of insurance based on their needs”. This is another conservative hot botton. They have a philosophical problem with the way that insurance works. They feel that people should be free to purchase only the amount of insurance they feel they need without regard to the risks or costs. They don’t seem to have a problem with Banks requiring homeowners to insure their homes up to a particular standard in order to get a mortgage. But they do have a problem with the government setting minimum standards on the sorts of healthcare coverage insurance companies must offer. Bloomberg explains that government standards preserve large risk pools which effectively reduce the costs for everyone.
Republicans are really saying that people should be free to avoid carrying insurance for problems they don’t expect to have (a bout of depression, maybe, or a stroke that requires rehabilitation) or don’t want to help pay for (pediatric and maternity care for men with no children, say). The former view shifts costs onto the unlucky; the latter shifts costs onto women and parents. Both undercut the purpose of insurance, which is pooling risk. Neither saves money. Yet in the abstract the argument sounds compelling. And it’s going mostly unchallenged.
What IS interesting in Bush’s plan is the suggestion that the government either directly or indirectly is the source, or underwriter of these catastrophic plans. This particular statement goes WAY further than Obamacare toward the single-payor socialism fears that birthed the Tea Party. Under Obamacare, the government does not issue insurance. The insurance comes from private companies. Those companies are regulated, but they ultimately get to set their own rates and determine in which markets they are going to participate and which populations they are going to target. The government only offers to subsidize the cost to purchase that insurance for those who don’t have the means to purchase that insurance on their own.
Obamacare is market-driven. The government works to make the insurance market in every state sufficiently lucrative that consumers in every state have choices. It has no mechanism to compel an insurance company to offer coverage in any particular state. Participation by insurance providers is entirely voluntary.
If the government is going to guarantee that every individual is able to purchase some form of catastrophic insurance at a rate that they can afford, who is going to provide that insurance? Who decides what that rate is? Who decides what the minimum coverage should be? How to do you handle the “free riders”, or does everyone get a minimum plan paid for by the government whether they like it or not? How does Bush plan to pay for all of this? A new tax?
That’s how Medicare works. One plan for everyone paid for by a payroll tax. We don’t require seniors to enroll in Medicare, but 85% of seniors do. Medicare doesn’t cover all expenses, but it does allow most seniors to retire without the worry of having to pay increased medical costs.
Jebcare is not a REAL plan. It is simply a set of talking points that allow Jeb Bush to appeal to the reptile brain of the Republican Party without actually working out any of the details.
Republicans DO NOT want to offer any kind of subsidized care for anyone. This isn’t an issue of cost or efficiency. Obamacare has already demonstrated that this approach saves money and improves health.
This is about philosophy. Republicans are social Darwinists who feel that poverty is the appropriate punishment for bad decisions made by people or their parents. Disease, in their minds, is just another motivation for making better decisions that should be preserved if we want to have a more responsible society. The rich are the vanguard for this righteous society. Their success is proof of their character.
Those of you who read the Bible, might recognize some similarity to the Pharisees. They felt that poverty and disease were punishments God meted out on the sinful. Jesus rejected that whole philosophy. Instead he reminded his disciples that His work (and the future work of all Christians) was to enlighten the world to a new way of thinking where love is the rule.
And as Jesus passed by, he saw a man which was blind from his birth. And his disciples asked him, saying, Master, who did sin, this man, or his parents, that he was born blind? Jesus answered, Neither hath this man sinned, nor his parents: but that the works of God should be made manifest in him. I must work the works of him that sent me, while it is day: the night cometh, when no man can work. As long as I am in the world, I am the light of the world. Matt 9:1-5
There is obviously a lot of work still to be done.