Thoughts on the Republican position on health care
The focus right now is on the Administration’s obviously flawed effort to implement the ACA and the problems with the ACA itself. An equally important topic that will eventually move to the center stage is the Republican alternative for health insurance markets. Debates often look like the old Miller lite commercial — good tasting versus less filling. The Republicans can chant flawed law and the Democrats can chant no alternative. A correct argument by one party does not make the argument advanced by the other party wrong. The argument that the law is flawed is not mutually exclusive with the argument that Republicans lack a viable alternative.
This morning I was thinking of the Republican position on health care when I ran across an article on Vice President Cheney’s views of the ACA.
The Vice President is a very smart, successful, accomplished man. A genuine American success story. Someone, regardless of our political views, is a person who can all look up to.
In this article Vice President Cheney discusses his early health problems.
There was a time in my life when I was about 23, shortly before we got married when I was sick, hospitalized and uninsured,” Cheney said. “I spent our honeymoon money on medical bills. Later on, I learned that I needed health insurance.
Even at 23, the Vice President had resources, a lot of pluck, and great intelligence. One thing that he lacks is empathy. A person with fewer resources, broadly defined to include God-given talents and money might not have recovered from the health and financial problems the Vice President experienced as a young adult.
The Vice President and most Republicans do not share the credo “there but for the grace of God go I” To them insurance is for the healthy and the affluent. Many people in circumstances similar to the ones experience by Vice President Cheney have a hard time obtaining and keeping insurance.
The Vice President’s anecdote illustrates the need for Republicans to clarify their views on the appropriate regulation of pre-existing conditions and premiums in the individual market. The Republican position and pre-ACA rules on pre-existing conditions was to put a small number of people in high-risk pools. The Republican position and pre-ACA rules on premium regulation was to allow total discretion at the state level. The Republican say they want to move insurance from the group market to the individual market. However, the individual market is not viable if insurance companies control both access to and price of insurance. Prior to the ACA individual insurance plans were a fringe part of the insurance market.
In the group market there was some protection prior to the ACA because federal law requires that insurance polices offer some group coverage to all small firms. (Premiums are often a problem when some members of the group get sick.) Without some regulation on insurance premiums and availability no one really has insurance. No one has insurance if discretion over eligibility to coverage and cost of coverage is ceded to insurance firms.
The case can be made that ACA regulations on allowable premiums are too rigid, especially given the need to persuade young health adults to purchase health plans. The problem right now is that Republicans have not offered alternative rules. The Republicans have made it clear that they want to repeal the ACA. This begs the question “What rules of any would the Republicans implement to govern pre-existing conditions and premiums and premiums in the small-group market?”
Vice President Cheney survived his early health problems and went on to have an illustrious career. He seems to believe that this outcome was inevitable. Millions of Americans have learned otherwise.