PERSPECTIVE FROM THE 19TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon, as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.
While the political world, if not the entire world, is focusing on the risks and rewards of U.S. action to take out, by drone attack, a terrorist in Iran, perhaps provoking a wider war there, I focus again today on health care policy.
If you read the Wall Street Journal over the last few days, it is possible to conclude that health care has returned to being a major issue for candidates running for president or for officials serving in Congress.
With impeachment, health care issues were relegated to the sidelines for several weeks.
Health care was at or near the top eAlhHHa few weeks ago when Democrat Senator Elizabeth Warren made headlines, not always positive ones for her, by releasing a plan showing how she would fund Medicare for All. The numbers didn’t stack up under scrutiny.
As has been the case in the past, my view – as I labor under a mistaken notion that my views matter at all — is that the typical health care debates suffer from a critical flaw. The flaw is opposition to what should be key tenet of any health care system – requiring buying health insurance “to make sure everyone is in the insurance pool.”
Getting everyone in the pool (including government programs to help those who don’t have enough money to buy coverage) is the only way to spread the risk – and, along the way, have at least a chance to reduce costs.
Without a mandate, those who happen to have insurance will pay huge sums for those who don’t.
In the past, I have used a comparison to automobile insurance – if you drive, you are required to provide insurance and, if you don’t, you pay a penalty.
Why not same for health insurance, as in – if you live, you have to have insurance coverage and, if you don’t, you pay a penalty.
Of course, my proposition for a “mandate” doesn’t go down well along the political trail. After all, it is another government mandate, which is enough to quell talk of it, almost regardless of where you fall on the spectrum.
Still, Bobby Jindal, the former Louisiana governor and presidential aspirant several years ago, showed up this week with a piece in the Wall Street Journal under the headline – “How the GOP Can Win on Health Care.”
His points, however, don’t just apply to Republicans; they work for anyone interested in making progress on the issue.
Here is a summary of Jindal’s prescriptions:
- Democrat presidential candidates are repeating one of President Barack Obama’s worst mistakes, one that arguably cost Democrats the 2010 midterms. Rather than focusing on bringing down medical costs — which are ever on the rise — Democrats are pushing policies that primarily aim to expand coverage and shift costs to taxpayers.
- As Obama did, the Democrat presidential hopefuls are pushing massive health-care overhauls, but paying only lip service to cutting costs. It’s now evident that the Affordable Care Act (ACA) did nothing to bend the price curve down, as Obama promised it would. One look at the math underlying Warren’s Medicare for All proposAl should dispel any illusions that the new plans will be any better.
- Most Americans like their health insurance as it is. Their complaints revolve around high out-of-pocket drug prices, deductibles and hospital bills. Insurers are increasing cost-sharing across health-care plans in an effort to curtail premium prices and tamp down overuse. Even a good policy won’t give you much relief from high deductibles and other out-of-pocket costs.
- Those who represent us have an opportunity to take the initiative on health care by focusing on what Americans actually want: Lower prices with minimal disruption. Congress recently took incremental steps in the year-end funding bill by repealing unpopular ACA taxes on medical devices and plans, but it failed to come to an agreement on the bigger problems of surprise billing and prescription-drug costs.
- Those with an interest in progress can craft a well-balanced, market-oriented mechanism to protect patients from surprise costs. Many insured patients are shocked to receive enormous bills from air-ambulance providers, emergency-room doctors, and anesthesiologists after a trip to the emergency room or a visit to what they assumed was an in-network provider but turned out not to be. These surprise bills, which can total thousands of dollars, are sent when particular providers are not in the patient’s insurance network, even though the hospital in which they work might be.
Jindal, a Republican, posits this point: “If Republicans don’t address voters’ frustrations, the public may be forced to choose more-radical options out of desperation. The best way to prevent a government-run health system is to offer solutions that lower prices based on competition and transparency.”
He has a good point, but, in the end, the basic issue should not just sit on the table: Require purchasing health care coverage so everyone has skin in the game.
And, this is an issue that should motivate everyone – Republicans and Democrats alike – who want solutions from middle, not the extremes of either far right or the far left.
Perspective from the 19th Hole 