Newt Gringrich's Heath Care Proposals

Posted by Sir Four at 11:15am Feb 11 '10
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Taking a look at what someone on "the other side" is proposing...

I think these ten points are fairly consistent with what many on the Right are asking for, so let's review:

#1 Give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.

This is similar to legislation proposed by some Republicans in Congress in the last year. There are several problems, however: a) giving individuals the tax credit while removing it from employers creates a powerful incentive for employers to end their health benefits, b) doing this without new regulations on insurance companies only exacerbates the difficulties for those with pre-existing conditions, and c) a generous tax credit sounds good for the individual but creates no downward pressure on premiums--in fact it gives insurers headroom to further inflate rates.

#2 Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines.

First part sounds good--portable insurance. How does an employer offer that type of insurance? I'm not clear on that. Allowing interstate purchases of insurance is problematic, because insurers could set up shop in the least regulated states and pursue all of the worst excesses seen in the industry. They'd be able to poach the most healthy people in states like mine (that place greater limitations on their bad behavior), creating a bad situation for people with pre-existing conditions.

#3 Meet the needs of the chronically ill. Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid.

Health savings accounts aren't going to meet the needs of the chronically ill. One could argue in favor of such accounts on their merits, but the above assertion does not make sense. And referring to Medicaid in the next breath really does not make sense.

#3, cont. We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted.

Health insurance plans for high-cost patients would be far more expensive than the average person could afford. The very purpose of insurance is for the healthy many to subsidize the care of the sick few.

#4 Allow doctors and patients to control costs. Doctors and patients are currently trapped by government-imposed payment rates. Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail. Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison shop on the Web. In short, they get paid when people are sick, not to keep them healthy.

What incentive is there for doctors to control costs? The fee-for-service model will always reward doctors for profiting off sickness and recommending expensive treatments. The Mayo Clinic offers an alternative; why has the Right not seized upon it?

#5 Don't cut Medicare. The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong. There is no question that Medicare is on an unsustainable course; the government has promised far more than it can deliver. But this problem will not be solved by cutting Medicare in order to create new unfunded liabilities for young people.

Say whaaa..?

#6 Protect early retirees. This is often the most difficult time for individuals and families to find affordable insurance. A viable bridge to Medicare can be built by allowing employers to obtain individually owned insurance for their retirees at group rates; allowing them to deposit some or all of the premium amount for post-retirement insurance into a retiree's Health Savings Account; and giving employers and younger employees the ability to save tax-free for post-retirement health.

The last part sounds fine. The part before that, though, not so much. Again, if we're decoupling insurance from employers by switching from a corporate to an individual tax break, one would think employers are going to provide fewer insurance options rather than new ones that don't currently exist. I'm also not understanding how employees would get the option of putting "some or all" of their premium payments into a health savings account.

#7 Inform consumers. Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible. Sources like Medicare claims data (stripped of patient information) can help consumers answer important questions about their care. Government data—paid for by the taxpayers—can answer these questions and should be made public.

Yeah, I agree completely on this. In fact, I bet we can go a step further and set up some type of mechanism to identify best medical practices and spread those to docs around the country.

#8 Eliminate junk lawsuits. Last year the president pledged to consider civil justice reform.

I'm open to tort reform, but it's important to consider that not all malpractice lawsuits are "junk lawsuits." True victims of malpractice, those who are left with a lifelong disability for instance, deserve significant compensation. Reform the hell out of malpractice lawsuits, but ensure that true victims still get their due. Also, if tort reform were to provide liability relief to docs, I would expect a commensurate reduction in the prices doctors charge. Tort reform cannot be passed simply to make docs richer.

#9 Stop health-care fraud. Every year up to $120 billion is stolen by criminals who defraud public programs like Medicare and Medicaid, according to the National Health Care Anti-Fraud Association. We can help prevent this by using responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.

Sounds great, but it also sounds like a trade-off toward more bureaucracy and government oversight.

#10 Make medical breakthroughs accessible to patients. Breakthrough drugs, innovative devices and new therapies to treat rare, complex diseases as well as chronic conditions should be sped to the market. We can do this by cutting red tape before and during review by the Food and Drug Administration and by deploying information technology to monitor the quality of drugs and devices once they reach the marketplace.

I agree that there are many times when it makes sense to cut through the red tape and get experimental treatments to patients in need. But are insurance companies going to cover the treatments?