I Don't Get the GOP Budget

by Tim Foley

Published April 02, 2009 @ 08:05AM PT

The new GOP budget is much better than the “principles” budget document, which was vague on details and, infamously, contained no actual numbers.  But I don’t understand the new GOP proposal for health care.  By this I don’t mean, “I don’t understand why someone would think this is a good idea” or “I don’t understand why this would substantially change the dynamic of costs” (cf. tort reform).  I mean I literally don’t understand it.

First, credit where it’s due on the rhetoric – they neatly encapsulate the problems of our health care system, the basic injustice of going bankrupt because of medical care, and the moral argument.  There even seems to be tough talk on discrimination based on pre-existing conditions (though if even AHIP is not justifying that practice, you know it’s hard to defend.)  But here’s where the wheels fall off the wagon.  In talking about the “private market” (pg. 21), the problem is not the business practices of private insurance, which we know are responsible for denying care, requiring multiple appeals, raising rates with little or no justification, creating insurance plans to attract younger, healthier customers but providing them with little protection, etc. etc.  Surprise, surprise, the actual culprit has been hidden all this time!

“It is not a failure of the market, but the ways the market has been distorted largely due to government policies and programs. They have undermined the doctor-patient relationship and removed the individual patient from the decision-making process.”

There may be an argument to be made here about specific government programs – but I have no idea, because they don’t make it.  This is probably because it very much is the fault of the market that it has undermined the doctor-patient relationship.  After all, private insurance is far more intrusive into the medical decisions of the doctor-patient relationship.  Also unnamed are the government policies or programs that are distorting the private insurance market.

And if it’s not better regulation or cost-controls or breaking down employer-based insurance (which is what John McCain wanted to do in his campaign plan), what is the solution?  “Central to this idea is putting American families and their doctors back in control of their health care needs.”  OK, that’s a goal, people, not a plan.  It reminds me of the candidate for Mayor in New York who said in a debate, “I would make [some program] a priority in my budget.”  She was pressed for specifics – how would you find the money for it?  How would you build a structure to make that happen?  Would you cut services somewhere else?  She just kept saying, “In my budget, it would be a priority.”

The budget then focuses on Medicare and Medicaid, effectively leaving the rest of us the country behind with some vague notion that if we just talked to our doctors, our insurance rates will go down and health care will be more affordable.  How do they get coverage for every American, a stated budget priority?  How do they prevent the private market from outside interference (never quite identifying who that Jungian tormentor is) that apparently is the real culprit for driving up health care costs – as opposed to increased use of costly and/or unnecessary treatments (which tend to be the decisions of doctors and patients), costs for the care of the uninsured absorbed by the system, and administrative waste?  How do they deal with more Americans losing their insurance as they lose or their job, or health care premiums in the private market rising at double the rate of inflation and three times as much as the cost increases cited by the GOP budget?

Apparently they have no answers for you.

(Photo credit:  matt.ohara on Flickr.)