The Republican Plan–Bobby Jindal

The keys to any health care proposal are affordability, community rating, guaranteed insurability and universal access.

Community rating “requires health insurance providers to offer health insurance policies within a given territory at the same price to all persons without medical underwriting, regardless of their health status.”

Guaranteed insurability and universal access implies that people will not be rejected for coverage because of preexisting illness and that insurance will somehow be made affordable to all.

In today’s Post Bobby Jindal touts 10 republican ideas on health care–none of which explicitly support affordability, community ratings, guaranteed insurability and universal access.

  1. Voluntary purchasing pools: The idea of purchasing pools and increased negotiating leverage are good but these same republicans opposed giving Medicare D (the medicare drug program) the same leverage.
  2. Portability-Can’t argue with the concept but the devil is in the details which are lacking. Jindal makes much of allowing consumers to “own” their policies, but doesn’t explain what that means. In any case one can only “own” something if it’s affordable. Jindal doesn’t mention the use of community ratings, so that those who need coverage most, i.e. those with illness, could afford the coverage.
  3. Lawsuit reform: I don’t have problem with this but where it’s been in vogue, such as Texas, malpractice rates have not declined and over-utilization remains the rule. See Gawande’s extensive damning piece in the New Yorker.
  4. Coverage of pre-existing illness: Jindal supports coverage of preexisting conditions. There’s nothing wrong with his suggestion except that without controlling rates, which is not discussed, such coverage is unaffordable.
  5. Transparency and payment reform: Providing more information of quality and cost is a terrific idea that both republicans and democrats can agree on. Rewarding efficiency and quality are also non-controversial but there are profound problems in determining what constitutes quality. For reasons that baffle me, republicans refuse to consider comparison studies between different treatment options. Seems like common sense but the drug companies sense that many of their marginal products will be proven ineffective and oppose this through their surrogates (republican and democrat) in congress.
  6. Electronic Medical Records: This is a good idea that may decrease duplication of medical procedures and improve the availability of information. No great cost savings are likely given the high cost of implementation and maintenance.
  7. Tax-free Health Savings Accounts: A republican shibboleth that does nothing to provide insurance to the average citizen (mean income $50,000/year). HSA’s work fine if you are wealthy but not at all if you are near of below the average or median income–that’s most of us.
  8. Reward healthy lifestyle choices: This is a seemingly Innocuous concept that increases charges to those at greater risk. This of course undermines the notion of “owning” insurance, coverage of pre-existing illness and guaranteed insurability. If we reward healthy choices it would not be long before someone would want to reward those whose genetic makeup show no increased risk–and ding those with genetic predisposition. I prefer encouraging healthy lifestyle choices in different ways than a sliding scale pricing. The cost of health insurance should be based on community norms, not an individual’s circumstances.
  9. Cover Young Adults: Terrific idea but Jindal want to keep them on their parent’s policies. So much for “owning” one’s own policy.
  10. Refundable tax credits: This an almost incomprehensible suggestion. He’d take money from the coverage for uninsured people to pay for non-emergent care. Previous republican proposals offered a tax credit that would not provide enough assistance to buy insurance. He avoids the issue of those who pay little or no taxes for whom a tax credit does nothing.


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