On Health Care Reform (Which is NOT Being Offered by Washington Republicans)

by D.J. McGuire

So, the Senate Republicans have, at long last, graced us with their plans for “health care reform” – quotes used because it isn’t health care reform. At best, it’s an attempt at health insurance reform much like “Obamacare,” which was corporatized health insurance cleverly disguised as socialized medicine. Regarding “Obamacare” – or, as I call it, the Patently Deficient and Unaffordably Careless Act – Congressional Republicans are far closer to Rinse and Repeat than Repeal and Replace.

Regarding actual health care reform, Washington would be best served doing what they could to increase health care supply. In that spirit, I present the following ideas (below the break).

First, take steps to dismantle state Certificate of Public Need Regimes. These effort by state governments to replace market forces in deciding what health care their citizens need has led to such disastrous distortions that the Obama Justice Department recommended they be scaled back or scrapped.  They have become Exhibit A for Regulatory Capture: in this case, by hospitals determined to preserve their profit margins by keeping out new competitors for health care services.

Said hospitals will insist that, due to federal law requiring them to treat any patient who reaches the Emergency Room, that competitive market forces don’t apply. That’s nonsense; what’s closer to the truth is that one intervention (said law) needs a countering one. Hospitals should be compensated for treatment provided, and since Washington forced them to take this financial risk, Washington could address it with compensation to hospitals for non-paying patients. This would be far more simple and transparent than insurance mandates (which were a way to address the issue by ensuring every patient would pay at least indirectly for services rendered).

This would make it easier for health professionals to set up shop in America, but it’s not all we can do. We can encourage foreign professionals to come here by loosening visa restrictions on doctors, nurses, etc. Our high-skilled immigration system is too restrictive in general, so health care isn’t the only field that could benefit from this, but it is the subject of this post.

Finally, it would be nice if Republicans remembered tort reform. That what was once a major part of every Republican health reform package for over two decades is nowhere to be found in 2017 says all one needs to know about how serious the GOP is about this. However, where actual health care reform is concerned, tort reform needs to be a part of it.

Now, this is not to say the health insurance market is just fine. It needs reform, too, and neither major party is considering what I think is the right direction of travel – namely: shifting government involvement from insuring based on income and age to insuring based upon risk – essentially an insurer of last resort. This could enable private insurers to offer less expensive policies, while poor and healthy Americans can buy better insurance on the private market. That would require serious changes to Medicaid (as age is a decent proxy for risk, I would leave Medicare alone).

More to the point, however, is that arguing about insurance policy – as we’ve been doing for over 25 years – has distracted us from the serious problems in the actual health care market. That needs to change, and quickly.

D.J. McGuire is the conservative Democrat on More Perfect Union podcast – and sometimes feels like he is the lone conservative Democrat in the country.

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