While Democrats emphasize [insuring] the uninsured, Republicans emphasize cost control. They [unlike an earlier generation of Republican conservatives] understand that it’s not a question of protecting health markets from government takeover. Government already controls and distorts health care. It’s a question of straightening out the system so that it is clear who is paying and for what.
Mitt Romney supports private insurance enforced by a universal mandate. [John] McCain talks about paying for outcomes rather than tests to cut down on unnecessary procedures. Mike Huckabee promotes an activist agenda to reduce obesity and prevent chronic illness.
When Brooks says "government already controls and distorts health care," that sounds like a bit of hyperbole to oldstyleliberal. But it's basically true. It's verbal shorthand for the idea that, mostly by virtue of running market-distorting programs like Medicare, Medicaid, and the State Children's Health Insurance Program (S-CHIP), Uncle Sam (along with state and local governments) influences the supply and demand relationships that pertain to medical-care goods and services.
That affects in a major way what health care items patients (or their insurers) can buy, and how much it will cost them to buy it. Accordingly, certain health care categories may cost more than they otherwise would, because (government-subsidized) demand for them is higher than it would otherwise be.
Because of said marketplace distortions, certain things may wind up being in too-short supply, even at higher prices; there may be too few doctors in a certain area of the country, because bureaucrats there have decreed that local health care providers don't get paid as much as they do elsewhere. So it may take a while to get a doctor's appointment in East Podunk. Meanwhile, there may be too many doctors and health care facilities in other areas, so eager patients may wind up having too many health care services bestowed on them, with no measurable improvement to their health, life expectancy, or any other objective indicator of the quality of their health care.
But, Brooks implies, GOP reform proposals (and those of Democrats) will not eliminate these market distortions. They simply hope to "straighten out the system" by at least making it more "clear who is paying and for what."
In the health care financing system as it is currently set up, it is not at all clear who pays for what. Even if you don't personally get any benefits from Medicare, Medicaid, or S-CHIP, and even if you do not have employer- or individually provided health insurance — you buy your medical care on a pay-as-you-go basis — you are probably already shelling out for the health care of other people.
If you, as a "young invincible" who normally "never gets sick," happen to undergo an emergency appendectomy at a local hospital, the bill which you are going to pay entirely out of your meager savings account probably has been inflated to help the hospital defray the costs of patients whose government-provided insurance programs — because of price controls or coverage limitations — don't fully defray the expense of treating them. That's what policy wonks call "cost sharing," and it also applies to the costs of treating charity cases: patients who have no insurance at all, government-provided or otherwise.
Cost sharing already distorts health care markets. Even if the government completely got out of the health care financing business — which is politically impossible, owing to the popularity of Medicare — and even if private insurers and HMOs acted in a totally greedy way to inflate their bottom lines at the expense of providing everyone with the health care we all so desperately need, the very fact that each of us can expect to use more health care than we can pay for, at some point in our lives, means cost shifting is inevitable. If all of the other market-distorting aspects of health care financing — government insurance programs, tax incentives to employers to provide health insurance for their workers, state regulations, etc. — disappeared overnight, cost sharing for charity cases would remain. And a great many of us, lacking huge financial reserves, would at some point become its beneficiaries.
So it is not a question of ever having a strictly market-based health care financing system, with zero distortions to "pure" supply-and-demand relationships. The "market footprint" of the government is, and will remain, huge. And unless we went to a full-bore "single payer" system of government-financed health care — an idea that has completely failed to gain political traction in America — there would continue to be private insurers, employers, doctors, hospitals, and managed care organizations who quite naturally fear their health care costs are getting way out of proportion to their levels of recompense. In a pinch, these entities, as recent history shows, tend to want to cut back their outlays — at the expense, too often, of making it too hard or even impossible for the sickest among us to get the care they need.
The Republicans all want to re-jigger the current system in various ways short of a single-payer system or a mandate that those who lack health coverage must buy it from the government. Romney would mandate the purchase of private insurance and would presumably arrange (somehow) for it to become available and affordable to all (good luck there!).
McCain would control health care costs by "paying for outcomes rather than tests." By that, oldstyleliberal assumes, McCain means health care providers would not be able to charge public or private insurers for procedures that don't measurably improve patients' health — though how that would be adjudicated is admittedly a bit of a mystery to oldstyleliberal at this stage.
And Huckabee emphasizes promoting "an activist agenda" to keep us from incurring serious (and expensive) illnesses in the first place: a noble goal, but again, good luck!
On the other hand, most of the GOP hopefuls' health care platforms contain, somewhere in the fine print, a plank that would permit the health savings accounts (HSAs) that became available to Americans under a 2003 law to become larger and less restricted. oldstyleliberal thinks this is a good idea. Accounts which are stocked with tax-free money, year by year, and which can be drawn upon at any age to buy health insurance and/or health services, while remaining tax-free, are a fine thing.
Right now, if you establish such an account, you are forced to buy so-called high-deductible health insurance along with it. The enlarged HSAs proposed by various Republican presidential hopefuls would eliminate that restriction and other drawbacks which keep HSAs from being as popular as they might be. oldstyleliberal thinks "large HSAs" would be the perfect complement to a universal-access health care plan such as Democrat Barack Obama proposes, which would make government-provided health insurance available to all adults and children but would mandate coverage only for children.
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