Russ McBee

So, what kind of country do we want, and what kind of people do we want to be?

We can either continue making the mistakes of the past, pretending they never happened, or we can really apply ourselves and solve the problems that face us. That's the choice we're facing when we vote in 2008. We face daunting crises with Iraq, global warming, the health care crisis, and a plethora of others. We can either continue with our heads in the sand, or we can begin fixing those problems with the industriousness and resolve which made our country great.

Mitt Romney is the embodiment of the first choice, and his health care reform proposal stands as Exhibit A.

As governor of Massachusetts, Romney co-authored a health care reform package, the goal of which is universal health care coverage for everyone in that state. It does so by mandating that everyone carry some kind of health insurance, requiring all businesses to provide at least a minimum coverage plan, and providing those without access to affordable insurance the ability to either enroll in a state-sponsored plan or receive subsidies to purchase their own plans.

As a contender for the GOP candidacy, he's now pretending that reform package never happened. In his race toward the bottom of the GOP pile, his proposal for national health care reform merely panders to the worst of the GOP base: those who ignorantly and blindly assume the "free" market is the solution to all society's ills and who equally blindly ignore the fact that our current health care crisis was caused by the "free" market in the first place.

Instead of the innovative solutions we really need, Romney's plan is more of the same unworkable and ineffective nonsense we've been hearing from the Republicans for years:

In a speech before the Florida Medical Association in Hollywood, Fla., Mr. Romney will present a program that won't include new government mandates for individuals or companies to buy coverage, policies long considered anathema by many conservatives -- and that were features of the program enacted in Massachusetts.

Instead, Mr. Romney plans to focus on tax breaks and streamlining regulations, policies his advisers say would essentially create a new, freer market for health insurance, driving down costs and providing incentives for individuals to buy their own plans.

He backpedals from what he did in Massachusetts just a couple of years ago:

The Massachusetts plan requires businesses to provide insurance for workers or help fund care for the uninsured, and it requires all residents to have some form of health insurance. It offers individuals without access to employer-sponsored plans government insurance or subsidies to purchase coverage.

For one thing, his new plan cluelessly turns employer-provided insurance benefits into taxable income, then offers tax breaks to those who probably can't itemize in the first place. As is all too sadly typical of Republican plans, this would punish the middle class and the working poor. For a family with pre-existing conditions, an individually purchased policy can easily cost $20,000 per year, with out-of-pocket deductibles that are equally eye-popping. Under a Romney presidency, those premiums would still be $20,000 per year; the deductibility of the premiums ignores the fact that most families can't afford $20,000 out of pocket in the first place:

Now Mr. Romney is proposing an approach many Republicans in recent years have embraced -- changing the tax code to spur more people to buy their own, private health insurance in the individual market. He will propose allowing more individuals to deduct their health-care premiums, co-pays and out-of-pocket expenses. That is aimed at altering the current system, where the cost of employer-sponsored group health insurance isn't considered taxable income.

An equally clueless libertarian gushes:

"Compared to what Gov. Romney did in Massachusetts, that would be a dramatic improvement," said Michael F. Cannon, director of health-policy studies at the libertarian Cato Institute, which has blasted Mr. Romney for the state plan. "If it's geared toward getting government out of people's health-care decisions by reforming the tax code, wow, that's fantastic."

To a libertarian, there somehow exists a connection between the government being involved in "people's health-care decisions" and the tax code, although that shadowy nexus is never really explained. To those types, it's "fantastic" to play bait-and-switch with the tax laws, whether it's relevant and workable or not. For people who don't have coverage and are uninsurable due to an existing condition, unaffordable premiums and deductibles hardly make for an attractive deal; tax deductibility for those people becomes nothing more than a cruel insult. There's nothing "fantastic" about it.

Apparently, Romney has also never heard of TennCare and the 300,000 kicked off the program due to "flexibility:"

Mr. Romney will also propose shaking up government funding of health care and giving states more flexibility to design their own plans for covering more of the uninsured. The plan envisions covering millions more low-income people, without new spending or taxes, by redirecting existing funds, including, if states choose, their allotments from the Medicaid program for the poor.

Medicaid is funded jointly by the federal government and the states, and it is an open-ended program in which federal spending grows as costs rise and more people join. Mr. Romney calls for replacing the current federal funding with a block grant...

Romney has some lofty goals for his proposal; it's just a shame his plan would accomplish none of them:

We're going to make health insurance affordable. We're going to get on track to have every citizen insured. And we're going to reduce the rate of growth in health care spending ...

That same article damns his proposal with faint praise:

His own plan is a blend of tax incentives, creative financing to help the uninsured without raising taxes or federal spending, and a state-based system that would depend on governors to fix the country's health-care problems.

Romney says his proposal

... would provide a tax incentive to buy high-deductible, low-premium health-care plans. And that, he said, would lead people to spend less and make better, cheaper choices in buying health care.

By "spending less," he means it would lead people to avoid seeking the care they need until it becomes an emergency, which is part of the current problem. The higher the deductible, the less likely policy-holders are to seek routine preventive care; preventive care is insanely cheaper than the cost of ignoring health problems until they become a crisis. This is part of the current problem, in which lack of preventive care among the uninsured ultimately leads to emergency room visits for things like preventable heart attacks and strokes. Those costs get passed on to the rest of us when hospitals raise their rates to cover the uncompensated expense of covering the uninsured. Our health insurance premiums continue to escalate as a consequence, and Romney's prescription to "spend less" would only exacerbate the crisis. If the uninsured had access to affordable coverage, they'd be much likelier to seek preventive care, which would in turn lower or eliminate uncompensated costs. We'd all benefit.

In fact, Romney's proposal would make the uncompensated cost problem even worse than that:

His proposal would help them [the working poor] buy privately purchased insurance by diverting up to $35 billion a year now spent by state and federal governments to pay emergency room bills for the uninsured ...

That means those emergency room bills will be added to the currently unsustainable levels of uncompensated costs, which already exceed $100 billion per year. I guess those uninsured will just be expected to avoid both preventive care and going to the ER. He'd be adding $35 billion to the uncompensated column, which is $35 billion more you and I will have to absorb in increased insurance premiums. He wants to move us backward, not forward.

More "free" market wishful thinking:

Romney would help lower private health-care premiums by working with states to cut regulations. Giving them a tax break on the cost of their premiums would draw as many as 6 million into buying insurance ...

Cutting regulations will not lower premiums; it will make them go up, unless "cutting regulations" means "letting for-profit health insurance companies expand the criteria for denying payment on claims." That's the only conceivable way cutting regulations could bring premiums down: by allowing the health insurance companies even more excuses to deny coverage. Not smart, Mitt.

The Boston Globe nails it:

He remembers insurance executives telling him about "so many mandates and restrictions and regulations on us; if you removed some of those we could get the premiums lower. . . . And we did."

There was a little bit of that in the final law, but what really makes it work is a system of government subsidies and regulation.

[...]

And GOP candidates aren't dwelling on the fact that federal, state, and local governments control 45 percent of heathcare spending, hardly the makings of a free market.

The most important healthcare issue in this presidential campaign revolves around the use of governmental power to insure the 43.6 million people who now live without coverage that is essential in modern life. Many Republican voters would rather hear denunciations of "mandates and restrictions and regulations." Let's hope Romney doesn't keep playing to this crowd.

The New York Times highlights some more nuggets from Clueless Mitt:

Mr. Romney will highlight how the nearly 45 million uninsured in the country can be divided into roughly three groups: about a third are eligible for public programs but are not enrolled; a third are low income but ineligible for public programs and need some help from the government to purchase health insurance; a third are middle income but have chosen not to buy health insurance.

That last group, I suppose, is intended to include those who can't afford $20,000 per year for a plan because of pre-existing conditions. If you're making $35,000 or even $60,000, refusing that kind of outlay is not a "choice," it's a necessity, but I guess it's too much to expect Clueless Mitt to understand that. Middle-income uninsured folks "choose" not to buy health insurance in the same way those poor people in New Orleans "chose" (to use Mike Brown's word) to stay behind and die after Hurricane Katrina -- they "chose" to stay there because they were too poor to buy their way out of town. Just as the levees failed and drowned them, our health insurance industry has failed and is drowning the working poor and middle class. To the conservative, "choice" means "not being rich enough to make the problem irrelevant for your family."

When Republicans say "regulatory reform," they typically mean "removing accountability." Romney's "reforms" certainly seem to conform to that pattern:

[Romney's reforms] would include reducing the number of requirements for coverage that states impose on health insurance providers or lifting restrictions in some states on health maintenance organizations.

Those "requirements for coverage" are things like requiring coverage of pre-existing conditions and not denying payment for legitimate costs. Romney would enable the health insurance companies to become even more arbitrary and capricious than they already are. This blog post says, seemingly without irony:

He would also reduce the requirements that states and the federal government put on private plans, a measure Republicans agree will make private insurance cheaper.

As I said above, this will only make private insurance cheaper if the corrupt health insurance companies turn around and use that de-regulatory environment as a reason to deny payment for legitimate claims. Underlying health care costs would continue to rise unabated.

And here's the aspect of the problem the "free"-market libertarians and pro-corruption GOP absolutely refuse to acknowledge:

Several experts, however, questioned the viability of aspects of Mr. Romney’s plan, including whether the proposed tax incentives will be enough to spur individuals to buy health insurance, without any consequences like they face in Massachusetts if they do not.

"Those individuals have free will," said Alan B. Cohen, executive director of the Health Policy Institute at Boston University. "They can go out and spend that money on anything they want. They might not spend it on insurance. If they don’t spend it on insurance, the rest of us still end up paying for their care."

This is one aspect of the problem those on the right seem never to understand. Health insurance premiums and medical costs will decrease only when 100% of the population is covered, and covered in a consistent, logical way. That will only happen if coverage is mandated by law.

This has turned out to be one long-ass look at one candidate's proposal, but I think it illustrates the question I asked at the beginning of this post. To be fair, I have to say that I'm unimpressed with the health care reform proposals put forth by any of them in either party, save Dennis Kucinich. As a cosponsor of HR 676, Kucinich would abolish for-profit health insurance and essentially extend Medicare to cover everyone in the country. Participation would be mandatory, universal, and consistent; that's the only way we'll get this crisis under control.

So, do we want to address this crisis once and for all, or do we want to continue pretending that the "free" market solves all ills, even those it created in the first place?