So Explain This: The Patient’s Choice Act as a Republican Alternative
Posted by J. Alexander Mitchell on 07.28.2009
Yes, there IS a Republican Alternative...
I have a theory – the key to whether or not you are content with the health care reform packages currently advertised is whether or not you trust the government more than big business. Neither viewpoint is inherently right or wrong for all circumstances. I tend to trust the government over big business for my needs (key word – NEEDS) because I believe private industry should be able to focus on making money over what is best for society. Others have different viewpoints.
A proposal based on that differing viewpoint – health care can be revolutionized by manipulating market forces rather than direct government intervention – was floated into Congress at the end of May. The Patient's Choice Act of 2009 represents the Republican alternative idea on the issue of health care. It is currently sitting in the Senate Finance Committee; this is important, as this is the committee likely to create the first version of a bill the Senate will vote for. Whereas it is doubtful - if due to nothing else but partisan politics - that it will pass as-is, many believe the Senate Finance Committee bill will be the first bipartisan one presented, so it is worth analysis simply to see what we may be able to expect out of the Senate bill.
I am working from the summary available on Representative Paul Ryan's official website; it is a very clear document that should be emulated for other pieces of important legislature. The bill has eight core pieces: prevention emphasis, manipulating the market to help patients, guaranteed choice of coverage options, fairness for every patient, compensation for patient injuries, no tax increases/government spending, government accountability, and fitting in state-level input. The first piece, emphasizing prevention and healthy lifestyles, involves creating a website that can provide a personalized prevention plan, increasing vaccination availability, and streamlining government programs. Included in this section is a prohibition on "junk food" in the Federal Food Stamp program.
States would have greater oversight under the PCA. As with most Democratic plans, each state would have an Exchange. These Exchanges would act is a "one stop shop" for health insurance, including the ability to easily enroll in a program. Any insurer in the exchange would be required to offer coverage to any individual with the same benefit standards used by Congress, and an independent panel would penalize those insurers in the exchange that cherry-pick only the healthiest individuals while rewarding those that accept high-risk customers.
Tax benefits would shift from the employer to the employee under the PCA; rather than giving a tax break to companies for insuring employees, individuals would receive a $2,300 tax rebate for individuals ($5,700 for families). In addition, individuals would be able to create Health Savings Accounts to store money tax-free for costs above their plan. Low-income families would receive approximately an additional $5,000 to assist in costs. This would partially replace some of the duties of Medicare, which would be streamlined to reduce inefficiencies.
Medical malpractice is heavily targeted in the PCA – each state will be able to set guidelines for efficiency, though, as a whole, an independent board of experts will be consulted rather than individual experts produced by both sides of a lawsuit, In addition, each State has the option of creating a Health Care Tribunal, which would have the same power to preside over lawsuits that state courts have. In some cases, both of these solutions would be allowable.
These are the grandest brush strokes of the legislature. It is worth it to read the summary; it is comparatively short with enough detail to answer general questions. How does this work as an alternative to a government option? My thoughts will come later…
The problem that all solutions still run into is that we have a supply shortage. I think part of any real solution in keeping costs down (keeping costs down and insuring more people are two completely different goals) would be increasing the supply of healthcare through tort reform and through educational and co-op grants that would encourage and sustain more doctors.
Posted By: J.D. Dunn (Registered) on July 28, 2009 at 02:24 PM
Dunn said "I think part of any real solution in keeping costs down (keeping costs down and insuring more people are two completely different goals)"
I'd go so far as to say that the two are diametrically opposed goals.
Posted By: J. Alexander Mitchell (Guest) on July 28, 2009 at 03:02 PM
In addition, individuals would be able to create Health Savings Accounts to store money tax-free for costs above their plan.
That strikes me as handing a hungry person a fork. An IRA effectively allows the exact same thing. You save tax free, and if an emergency strikes you can take the money out. No new help at all. And having "costs above their plan" runs counter to the very concept of insurance. I pay every month so if disaster strikes I won't face a financially crippling bill. Deductibles make sense, caps do not.
Medical malpractice is heavily targeted in the PCA – each state will be able to set guidelines for efficiency, though, as a whole, an independent board of experts will be consulted rather than individual experts produced by both sides of a lawsuit, In addition, each State has the option of creating a Health Care Tribunal, which would have the same power to preside over lawsuits that state courts have. In some cases, both of these solutions would be allowable.
Having lived in America for more than five minutes, I see potential for massive graft and corruption here. You might as well name the health insurance CEO's to the Tribunal straight away and skip any attempt to appear above board.
These aren't even serious proposals. You could fly a 757 through the loopholes. Conditioning people to pay more and more for less and less coverage is not reform.
Posted By: Shockmaster (Guest) on July 28, 2009 at 03:05 PM
I don't really see how this lowers costs at all? We are still relying on the individual to be able to pay for these costs and not really concentrating on bringing costs down.
We are under the assumption with this plan that creating these "exchanges" will lower costs...who is to say that will happen? Who is to say the lobbyists that currently infest Washington on the health Insurance lobby behalf wont also get involved in these exchanges?
While it appears you wont be turned down for coverage it still doesn't really rectify costs to the family or individual and THAT is the main problem.
Posted By: saywhat (Guest) on July 28, 2009 at 03:21 PM
How are people proud to be american?
Posted By: Kent Baker (Guest) on July 28, 2009 at 03:46 PM
You get or prefer getting your "needs" from the Government? I can't imagine relying on the government for food, shelter, electricity or clothing unless I was in prison. To me, it is odd to think that "making money" and what is "best for society" are mutually exclusive.
I find it highly suspect that anyone would actually believe that government policy is motivated by what is "best" for society.
Its philosophically preposterous to believe that any institutions is capable of define a unique set of conditions that is thought of as "the best". Democracy can only prevent the worst from holding office, it is incapable of defining "the best".
The PCA is intriguing. It is especially refreshing to see a Congressman actually lay-out a specific plan for consideration. I tried to find specifics from the transparent Obama Administration but learned that they are not making any specific policy recommendations. The Administration is so transparent, one can look right through and not see anything.
Posted By: AdmChesterMynutz (Guest) on July 28, 2009 at 05:40 PM
How are people proud to be american?
Posted By: Kent Baker (Guest) on July 28, 2009 at 03:46 PM
All you do is talk shit. No one cares what you think Kent. Now go watch your shitty football were you punt on third down.The CFL pretty much sums Canada up.Substandard product were the only good players are from America.
Asshole.
Posted By: John (Guest) on July 28, 2009 at 07:26 PM
"You get or prefer getting your "needs" from the Government? I can't imagine relying on the government for food, shelter, electricity or clothing unless I was in prison. To me, it is odd to think that "making money" and what is "best for society" are mutually exclusive.
I find it highly suspect that anyone would actually believe that government policy is motivated by what is "best" for society."
If I have a choice between relying on a government in which I elect the officials or a private company where I have no say in who's involved in the running of the operations, I'll choose the option where I at the very least elect those in charge. Then theoretically they have to answer to me. A private company only answers to its stockholders (if it's even publicly traded).
I could discontinue my business with that company but that in no way means the company will be harmed, as it can always branch out and find new ways to generate revenue to compensate for losing me. It's far harder for a politician to compensate for lost votes.
Posted By: Guest#7076 (Guest) on July 28, 2009 at 07:34 PM
But because they punt on the 3rd down it makes the game faster and more aggressive.
You must be from New York John. You need to relax, war and yelling isn't always the answer.
Posted By: Kent Baker (Guest) on July 28, 2009 at 08:14 PM
Seattle, Wa actually Kent, hey quick question, if your health care is so great then why are there a bunch of canucks down here at our medical clinics?
As for more aggressive football, I disagree.There is little or no running game.Smash mouth football does not exist. Its like watching a bunch of frat boys playing nerf 7 on 7.
Posted By: John (Guest) on July 28, 2009 at 08:53 PM
he CFL pretty much sums Canada up.Substandard product were the only good players are from America.
Posted By: John (Guest) on July 28, 2009 at 07:26 PM
Hey, leave our football teams alone. Saskatchewan fans will start sending death threats.
Posted By: Mikel (Guest) on July 28, 2009 at 10:33 PM
"if your health care is so great then why are there a bunch of canucks down here at our medical clinics?"
Because we have the right to seek out alternate care if we are willing to pay through the nose for it. And please try not to make assumptions about our healthcare system - Canadians voted its pioneer (Tommy Douglas) 'The Greatest Canadian'. OK, it was for a TV show, but still! And at the risk of jumping the gun, I would find it horribly offensive for you to tacitly suggest that you know more about our health care system than we do - even if you are from an awesome city like Seattle (went there a couple months back).
Now back to more important topics... I actually prefer American football.
Posted By: Canadian (Guest) on July 28, 2009 at 11:13 PM
"I could discontinue my business with that company but that in no way means the company will be harmed, as it can always branch out and find new ways to generate revenue to compensate for losing me. It's far harder for a politician to compensate for lost votes."
Actually, your analogy is deeply flawed based on the inconsistency by which you apply scale. It may be easier to generate revenue than to compensate for lost votes, though that is debatable in and of itself, however, on a macro level, the loss of, say, hundreds of customers to a business would be just as devastating as a loss of hundreds of votes.
Furthermore, your assumption is based on the fallacy that your representative will in some way be responsible for administering the hypothetical service in your example. An unelected administrative beuracracy would be set up to oversee your service, and you would have still have no say in who's administering your service. Furthermore, if you assume the government is the sole provider of said service, then you not only have no say in who is "running" it, you also have no choice if you are disatisfied. And if you tried to discontinue your use of said service, as you might do with a private company, you will still have to "pay" for or, perhaps more accurately, fund that service whether you are receiving the benefits of it or not. Now, let's assume the government service, while omnipresent, is not the only service available. You can take your business to a preferable private provider, however you are now funding the government service and paying for private service.
Posted By: Guest#3864 (Guest) on July 29, 2009 at 12:56 AM
"Medical malpractice is heavily targeted in the PCA – each state will be able to set guidelines for efficiency, though, as a whole, an independent board of experts will be consulted rather than individual experts produced by both sides of a lawsuit, In addition, each State has the option of creating a Health Care Tribunal, which would have the same power to preside over lawsuits that state courts have. In some cases, both of these solutions would be allowable."
I agree Shockmaster, corruption would be inevitable. I somehow doubt we would hear conservative talking heads running around shouting about "the destruction of the constitution" with this massive power grab away from the judicial branch either.
Posted By: null2099 (Guest) on July 29, 2009 at 05:20 AM
The Republican system: "screw the poor"
Posted By: M:-X (Guest) on July 29, 2009 at 05:58 AM
Adm - this is not a "specific plan". It is an actual bill that is "stuck" in committee (read: being integrated into a new bill).
It is hard to compare it to the "Presiden't Plan" because there are multiple Democratic bills out. President Obama, however, HAS listed his thoughts; he named the limitations and ideas he had in his speech last Wednesday.
However, please remember that he does not write the legislation, so there is no way for him to have a "comparable plan".
I find myself wondering where most of the Right Wing Brigade is and why they have not chimed in...
Posted By: J. Alexander Mitchell (Guest) on July 29, 2009 at 10:17 AM
The Democrat's/Progressives System: screw everybody because that's what's "fair" (except the politicians because they are so much better than the peons they represent).
Posted By: Da Man (Guest) on July 29, 2009 at 11:19 AM
Ah, John, living out every negative American stereotype: Brash, ignorant, LOVES his American Football and loves to talk about things he knows nothing about. Have fun living in your bubble and waving your blood-soaked flag while the rest of the civilized world actually does something to help other human beings – you know, being humanitarian and all – a concept that I’m sure is as foreign to you as a Mexican crossing into Texas.
Posted By: The 8th Samurai (Guest) on July 29, 2009 at 11:57 AM
You actually believe your vote matters? Your arguing the counter-factual. How could you possibly know that your life would be better through getting your needs from a government institution when all of your necessities are provided through markets.
Do the math my friend, your value to a politician's success is worth far less than your value as a patron to the success of a private company.
Here is an experiment. Call your representative in the House with a complaint about the administration of a federal program you are a participant. Simultaneously, call the regional manager of Home Depot in your area, and lets see who calls you back first.
Posted By: AdmChesterMynutz (Guest) on July 29, 2009 at 12:26 PM
'Ah, John, living out every negative American stereotype: Brash, ignorant, LOVES his American Football and loves to talk about things he knows nothing about. Have fun living in your bubble and waving your blood-soaked flag while the rest of the civilized world actually does something to help other human beings – you know, being humanitarian and all – a concept that I’m sure is as foreign to you as a Mexican crossing into Texas.'
Yes, because the rest of the 'civilized world' is doing tons of good to contribute to the impoverished of the world, and they always have. I assume you're talking about Canada and Europe, and if you are, you're a total moron who cannot be taken seriously. Europe does NOTHING that doesn't bring them massive upside. Their 'humanitarian' actions are a complete joke.
I haven't come in to make any comments because I'm in 100% agreement with Dr. Paul's plan.
Posted By: The Man (Guest) on July 29, 2009 at 03:25 PM
"How could you possibly know that your life would be better through getting your needs from a government institution when all of your necessities are provided through markets."
------
Well thats an easy one, when the bottom line on the ledger sheet is the deciding factor in a private companies decision I know FOR SURE I dont matter.
When they decide to go with a different insurance plan that makes me pay more for less because it saves them money. Or when an insurance company decides to deny treatment to someone because they do not want to pay out.
The other plan would not have the same problem...the bottom line would not be the all deciding factor on care - I would feel much more comfortable taking my chances in a system like that.
To each is own though
And truth be told...your vote does matter because without it these guys are out of a job.
Try voting out the district manager of home depot and see how far that gets you as a private citizen.
Posted By: saywhat (Guest) on July 29, 2009 at 04:11 PM
J.,
Thanks, but having plan submitted in a bill does not nullify it as a plan. There are a myriad of ways for him to give a specific proposal for consideration by Congress. So yes, I do remember the President is not a legislator while also clearly acknowledging the President is part of the legislative process.
As with all politicians, his lack of specificity is pure political calculus. I don't fault him for being a politician. If he gives a specific proposal as the Clinton Administration presented (who also did not "write the laws") to Congress in the form of a specific legislative proposal and lost, it would be a Waterloo moment for this policy area. By not being specific, he can sign whatever Congress sends to him and then campaign on delivering health care reform.
Its smart politics. Its a shame to me that his supporters believe his administration as being straight-up policy analysts working on behalf of you and me rather than giving him credit for what is his obvious strong suit. being a politician.
Posted By: AdmChesterMynutz (Guest) on July 29, 2009 at 05:29 PM
Leave ACORN's power unchecked ($4 billion of our tax dollars going to them via porkulus) and see how easy it becomes to vote out Democrats who are rationing your healthcare after ACORN rigs the voting rolls with an assist from the Holder Justice Department, who will keep arcane Civil Rights Voting act provisions in place to "oversee" voting districts and make sure they don't verify who is actually voting because that is apparently "racist".
Posted By: Da Man (Guest) on July 29, 2009 at 05:48 PM
"I can't imagine relying on the government for food, shelter, electricity or clothing unless I was in prison."
Military? Public School? Everywhere else in America? The government subsidizes everyone's electric bill whether they know it or not.
"Leave ACORN's power unchecked ($4 billion of our tax dollars going to them via porkulus) and see how easy it becomes to vote out Democrats who are rationing your healthcare after ACORN rigs the voting rolls with an assist from the Holder Justice Department, who will keep arcane Civil Rights Voting act provisions in place to "oversee" voting districts and make sure they don't verify who is actually voting because that is apparently "racist"."
You forgot to bring up his birth certificate. I'm disappointed.
From Politifact:
"We read the fine print from the House version of the stimulus package and saw no money designated for ACORN, or any other specific nonprofit organization. Kirstin Brost, a spokeswoman for the Democratic chairman of the House Appropriations Committee, said the lion's share of the neighborhood stabilization funds would go to local governments. But the authors of the stimulus plan decided to open the process to nonprofits, she said, because they have found that some local governments could not, or were not interested, in participating in the program.
"Some local governments were very good and some local governments didn't have the capacity to do it and the money just sat there," Brost said.
Under the House plan, nonprofits would be allowed to compete to do some of the work. They would have to prove they are "capable of moving the money out the door quickly and efficiently," Brost said. "They would have to go through stringent competition. They would have to use the money to purchase homes, renovate them and then rent them out or resell them. They couldn't use it for anything else. ... We absolutely have to do something about foreclosed homes."
If Democrats were trying to steer money to ACORN, say ACORN leaders, they sure picked an odd way to do it. ACORN has never done this type of foreclosure work, and according to ACORN's chief organizer, they don't plan to."
Posted By: J.D. Dunn (Registered) on July 29, 2009 at 07:20 PM
This is the worse alternative I've heard in my life. It is almost like trying to argue "Just shoot the guy in the head. You can save his life, but he'll die anyway." This plan does nothing to really address the problem. I'm very disappointed in the Republicans for trying to pass a proposal like this.
Posted By: David (Guest) on July 30, 2009 at 04:54 AM
JD, I noticed you had no snarky little fact check comment for the other part of my commentary of the Holder justice department overriding the ability of states to verify voter identities during elections. What, no "above-the-fray" website to cite for that to try and belittle my attempt to demonstrate to the people who trust government blindly of the POTENTIAL for corruption?
Oh, but your little fact check certainly reassured me that the $787 billion porkulus will in no way find it's way into the hands of ACORN because it's going to be funneled through local governments first. I feel so much better now. I'm sure the geniuses running the California government will make sure that money goes where it needs to go.
Thanks.
Posted By: Da Man (Guest) on July 30, 2009 at 12:33 PM
The military cultivates its own food? Builds in own shelters and weaves its own cloth. I didn't know that. It was my understanding that the military purchased food, housing and uniforms from private producers. Given I am not currently in the military, I still can't imagine getting my food, clothing or shelter from a government. I've also never known a public school to cultivate food, build shelter, produce electricity or weave cloth for mass consumption. Therefore, I can't imagine getting any of these needs from a public school. The public school in my area actually purchases food to give to students, but not adults. How does subsidized production of electricity equate with government produced electricity? Now if we were in Venezuela where the entire energy sector has been nationalized I do see where the government can provide electricity. But that is probably a bad example because the governments lack of capital equipment maintenance means that the costs of providing electricity through government far exceeds the cost of privately produced electricity.
I stand by my statement.
Posted By: AdmChesterMynutz (Guest) on July 30, 2009 at 01:51 PM
"JD, I noticed you had no snarky little fact check comment for the other part of my commentary of the Holder justice department overriding the ability of states to verify voter identities during elections. What, no "above-the-fray" website to cite for that to try and belittle my attempt to demonstrate to the people who trust government blindly of the POTENTIAL for corruption?
Oh, but your little fact check certainly reassured me that the $787 billion porkulus will in no way find it's way into the hands of ACORN because it's going to be funneled through local governments first. I feel so much better now. I'm sure the geniuses running the California government will make sure that money goes where it needs to go.
Thanks."
You lied. I corrected you. That's the extent of our relationship, "Da Man."
"Given I am not currently in the military, I still can't imagine getting my food, clothing or shelter from a government. I've also never known a public school to cultivate food, build shelter, produce electricity or weave cloth for mass consumption. Therefore, I can't imagine getting any of these needs from a public school."
How does any of this relate to reality? No one said anything about cultivating or production by the government. The don't do that in prisons either, btw.
You talked about needs. I gave you examples of needs the government fulfills. You moved the goal posts to say production.
Posted By: J.D. Dunn (Registered) on August 02, 2009 at 10:30 AM
JD,
Wasn't a lie. Maybe I had the facts wrong (arguable, at best) but a lie is the knowing misrepresentation of the facts.
In two years if ACORN is found to not have received an obscene amount of money from that craptacular "stimulus" bill, I will admit I was mistaken.
I take solace in the fact that you were reduced to childish name calling to refute me however. Hardly the character trait one should have who tries to act as cooly detached from the fray as you do. What will all your fans say?
Posted By: Da Man (Guest) on August 03, 2009 at 02:25 PM
Da Man,
JD called you names and behaved like a child? Does this stem from the word "lied"?
Little bit of a stretch, but I s'pose that seems to be your preferred method of argument construction around these parts.
Posted By: Scotty H (Guest) on August 06, 2009 at 11:40 AM
STAY CURRENT