Some Conservative Ideas on Health Care Reform- Analysis

Conservative Case for Reform- Bobby Jindal
Washington Post - Oct. 5th

Louisiana Gov. Bobby Jindal doesn’t like what’s happening within the healthcare debate. He says Democrats are over-reaching and reform will lead to huge deficits and major problems but he also says the Republicans have to engage in the debate and start proposing ideas and changes.

I enjoy analyzing these health care proposals and showing their difficulties. My comments are in bold/ italics. So far Jindal and other conservatives have offered virtually nothing that is helpful.
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Mr. Jindal-
A majority of so-called Republican strategists believe that health care is a Democratic issue. They are wrong; health care is an American issue, and the Republican Party has an opportunity to demonstrate that conservative principles work when applied to real-world problems.

But memo to Washington: The debate on health care has moved on. Democratic plans for a government takeover are passé. The people don't want it. Believe the polls, the town halls, the voters. Only Democrats in Washington would propose new taxes on businesses and families in the middle of a recession, $900 billion in new spending at a time of record deficits, and increased taxes on health insurance and products to reduce health-care costs.
Washington is the only place in the country that doesn't realize that this debate is over. Democrats may march forward anyway, but they will do so without the people, and at their own peril.
Yet hope for meaningful reform need not be lost. Only two things need to happen. First, Democrats have to give up on their grand experiment and get serious about bipartisan solutions. Second, Republicans have to join the battle of ideas.
To be clear, the Republicans in Congress who have led the opposition to the Obama-Pelosi vision of health-care reform have done the right thing for our country. If they had rolled over, the results could have been devastating for our health-care system and our nation's budget.
But Republicans must shift gears. Conservatives should seize the mantle of reform and lead. Conservatives either genuinely believe that conservative principles will work to solve real-world problems such as health care or they don't. I believe they will.
The people do not want Republicans to offer their own thousand-page plan to overhaul health care, and that is not what the nation needs.

So here are 10 ideas to increase the affordability and quality of health care. Some of these are buried within various Republican and Democratic plans that have been floated. They offer a path forward toward significant bipartisan reform. These proposals would require insurance companies to do their jobs and spread risk over large populations, restore patients' power to make their own health-care decisions, and focus our system on quality instead of activity.

1-- Voluntary purchasing pools: Give individuals and small businesses the opportunities that large businesses and the government have to seek lower insurance costs.
This is included in the Dems plans

-- Portability: As people change jobs or move across state lines, they change insurance plans. By allowing consumers to "own" their policies, insurers would have incentive to make more investments in prevention and in managing chronic conditions.

If health plans are portable across state lines this may strip state mandates from plans and water down essential coverage protections- i.e. mammography and birth control for women, chiropractic care and others. Portability is good as long as the individual state rules apply.

-- Lawsuit reform: It makes no sense to ignore one of the biggest cost drivers in the system -- the cost of defensive medicine, largely driven by lawsuits. Worse, many doctors have stopped performing high-risk procedures for fear of liability.

This is a no-brainer.

-- Require coverage of preexisting conditions: Insurance should not be least accessible when it is needed most. Companies should be incentivized to focus on delivering high-quality effective care, not to avoid covering the sick.

Ditto- a no-brainer.

-- Transparency and payment reform: Consumers have more information when choosing a car or restaurant than when selecting a health-care provider. Provider quality and cost should be plainly available to consumers, and payment systems should be based on outcomes, not volume. Today's system results in wide variations in treatment instead of the consistent application of best practices. We must reward efficiency and quality.

I'm glad he gets this, but quality outcomes and care should also be incentivized within payment reform.

-- Electronic medical records: The current system of paper records threatens patient privacy and leads to bad outcomes and higher costs.

Yup, a no-brainer again. So far I'm not real impressed.

-- Tax-free health savings accounts: HSAs have helped reduce costs for employers and consumers. Some businesses have seen their costs decrease by double-digit percentages. But current regulations discourage individuals and small businesses from utilizing HSAs.

This is a very slippery slope. HSAs are not the be-all, end-all answer the GOP hopes, but instead provide cost-savings for a niche market. Conservatives think HSA's are a savior but if you think reform is good if it means everyone has a $5,000 annual deductible while docs are not encouraged to increase quality and efficiency then we'd all be in for a wild ride to poor health.

-- Reward healthy lifestyle choices: Providing premium rebates and other incentives to people who make healthy choices or participate in management of their chronic diseases has been shown to reduce costs and improve health.

Good idea, cost-share incentives could be included for those who test in the highest percentages of health.

-- Cover young adults: A large portion of the uninsured are people who cannot afford coverage after they have "aged out" of their parents' policies. Permitting young people to stay on their parents' plans longer would reduce the number of uninsured and keep healthy people in insurance risk pools -- helping to lower premiums for everyone.

This is a good proposal, but often young people cannot afford the coverage in the first job's out of college because they make too little. I presume Mr. Jindal is thinking of only those with no access.

-- Refundable tax credits (for the uninsured and those who would benefit from greater flexibility of coverage): Redirecting some of the billions already spent on the uninsured will help make non-emergency care outside the emergency room affordable for millions and will provide choices of coverage through the private market rather than forcing people into a government-run system. We should trust American families to make choices for themselves while we ensure they have access to quality, affordable health care.


Tax credits are the GOP solution that makes no sense. Reducing individuals taxable income by $5,000 does virtually nothing for their ABILITY to buy health insurance. I use dependent care reimbursement to get reimbursed for my daughter's daycare. The tax savings I enjoy from this amounts to about $1,000. My daughter's day care expenses are about $10,000 per year. This does so little to help its laughable. Health care is even worse.