I was reading Wisconsin Republican Representative Paul Ryan’s “Roadmap for America’s Future,” and the section on health care reform made me sad on many levels. Remarkably, for dealing with the uninsured below the age of 65, Ryan’s plan is very similar in general outline to the Senate health care bill. In both plans, people will get tax credits to buy insurance on new state-based exchanges. I doubt this is a sign of how “centrist” the Senate bill is, and more a sign of how incredibly corporate friendly it is. Even Republicans have a tough time thinking up a better giveaway to the insurance industry. I find it hilarious and depressing that Ryan’s tax credits, state-based exchanges, and loose regulations can be the free market solution, while Baucus’s tax credits, state-based exchanges, and loose (but slightly tougher and more sensible regulations) are a massive “government takeover.”
The most disappointing part about Ryan’s “Roadmap for America’s Future” is that it isn’t even an intellectually coherent plan to deal with health care reform. Paul Ryan is considered one of the best policy guys in the Republican party; yet, from this roadmap, it appears that one of the two major parties in this country is simply incapable of coming up with complex solutions to problems like health care without contradicting itself. It is amazing that, given a blank slate to create his ideal health care solution, Ryan still can’t think of one that actually makes sense. It is even more amazing that the Democrats are desperate to work the Republicans after Republicans showed that they have no good ideas on health care.
Take, for example, these passages:
State-Based Exchanges. Health care services should be easier to use, should be more predictable, and should provide integrated care in a more equitable manner. The current regulation of the insurance market does not give health plans incentives to cover sick patients. When patients do get sick, insurance companies have an incentive find ways of preventing that person from re-enrolling in the insurance plan. Insurance reform must be the linchpin of any health care reform. A one-size-fits-all approach dictated by Washington cannot solve the diverse problems that citizens in various States face. What is needed is a consistent and fair market, so everyone can afford coverage. Patients should choose which health care provider they trust. The freedom to choose creates enhances competition, fosters higher quality care, and puts downward pressure on costs, making care more affordable.
Geographic differences are a significant driver of current health care problems. The characteristics of patient populations differ from State to State. This means the type of basic medical care also differs from State to State. A uniform, national health care plan ignores these regional differences and lowers the standard of care the medical community can provide. Allowing each State to develop and regulate health coverage that meets the unique characteristics of its population and economy will encourage the innovative and patient-oriented health care that should be the hallmark medicine in America.
Now, compare the logic in those two paragraphs to these paragraphs about selling insurance across state lines that come almost right after that in the same document:
Interstate Purchasing. Currently, individuals and families can purchase health insurance only in the States in which they live, because insurance companies are prohibited from selling polices outside their respective States. Thus the consumer is prevented from purchasing coverage from another State that might offer more suitable, or more affordable, coverage.
This proposal breaks the lock, allowing each individual to use the refundable tax credit toward the purchase of health insurance in any State. This will greatly expand the choices of coverage available to the consumer, and also will encourage broader competition and diversity among insurers, who will be able to sell their policies to individuals and families in every State, as other companies do in other sectors of the economy.
(First of all this is just a lie. Insurance companies can and do sell in multiple states right now. They just need to be registered in every state in which they sell insurance, and follow the laws in the state where they are selling policies.)
So, here we have Paul Ryan arguing that health care is so localized in its issues that it must be regulated and dealt with at a state level. Then, right after saying that, he says people must able to shop nationally for insurance. If you want people to buy insurance from all over the country, that means, by definition, that you don’t think it is a product that should be dealt with locally. How can a state “develop and regulate health coverage that meets the unique characteristics of its population” if most of the state’s population is buying insurance from other states, or most of the people buying insurance in the state are from across the country?
The incoherent logic is amazing, and a sign of how intellectually bankrupt the Republican party is when it comes to finding new solutions. The best they can come up with is a lame (and much worse) rip off of Senate Democrats’ corporate giveaway bill.
I was hoping the Republicans would at least be creative and innovative. Maybe they could have pushed for a Singapore-style system of health savings accounts and extreme catastrophic insurance. That, at least, plays to their talking points and is a coherent plan proven to work elsewhere.
I don’t know which is worse news for our country, the fact that one of the two major political parties is basically incapable of coming up with logical solutions to major problems, or the fact that the other party desperately wants to work with them and keeps saying how much they want to adopt their illogical ideas.
Democrats need to start making the case that Republican ideas are not just wrong for the country, but just plain stupid. That the reason Democrats can’t get Republican votes for health care is because Republicans can’t even think logically about the problem. The more Democrats demand bipartisanship the more they convince voters that what we really need is to elect more Republicans. After all, why else would Democrats constantly beg Republicans to work with them unless they thought they had great ideas and should play a bigger role in Congress through having more seats?