Health Care Redux

In the summer of 2008, better than 75% of Americans wanted something done about the medical marketplace in our country. By overwhelming margins, Americans believed it an embarrassment that this country lacked the capacity to care for its citizens. The explosion in costs for average working Americans was also a driver in public opinion, as well as the knowledge that our country ranked behind most of the industrialized world in most key health statistics.

The winter of 2009/2010 has not seen a change in public opinion on the keys for health care reform, but it has seen the success of the most ambitious and well orchestrated branding campaign in political history. In poll after poll, Americans say that they favor a repeal of the anti-trust exemption for insurance carriers, some form of publicly administered plan to provide low cost competition, and the prohibition of pre-existing conditions and rescission. All of the plans proposed, including the two that passed the House and Senate, contain these remedies in some degree. All of the plans proposed have also become universally unpopular.



We are left with these articles of confusion; the public likes the individual elements of the bills, but dislikes the bills. The Constitution provides for majority rule, and the passage into law of provisions when they are passed in both the House and the Senate and signed by the President. The health care bill that passed the Senate did so in spite of the fact that it had to achieve 60 votes for every procedural step…majority rule was essentially suspended for this bill. For the first time that I can find, a measure that passed in both houses of Congress is not going to find its way to the President’s desk.

Through all this, the working class of the country have suffered while both parties have played games. Early in the process, the Democrats (led by Max Baucus) negotiated away a key part of health reform when they cut a deal with Big Pharma. The deal provided for the pharmaceutical industry to control cost growth by indexing prices using 2009 as a baseline; of course those companies have not so mysteriously taken major price increases throughout the year. For the rest of the process, Republicans have missed an opportunity to legislate due to their strategy of opposition.

The Republican party has not proposed a health care reform package. The party of inflation-fighting fiscal responsibility has not proposed legislation on an industry whose inflation rate is four times that of the overall rate AND household income. A reform package built on traditional conservative principles is not hard to imagine….so I will articulate one here.

  1. Repeal the anti-trust exemption. The market can’t work in the presence of a monopoly, and the exemption allows the insurance companies to act as a cartel. Conservative icon Teddy Roosevelt lead the charge to “bust up the trusts”, so why aren’t John Boehner and Mitch McConnell interested?
  2. Eliminate the patent monopolies for prescription drug makers. Allow competition! The patent monopolies allow Big Pharma to set the price at the highest point possible for ten years. They leverage this by spending huge sums on advertising designed to pull consumers into the doctor’s office and demand their products (drug firms spend as much on marketing as they do on R&D…think about that the next time you see Montel Williams and his prescription drug bus).
  3. Allow for free trade in pharmaceuticals. Bayer is a German company folks, and the government telling Wal-Mart, Walgreens, CVS, and others where they can and can’t buy their products isn’t very conservative, now is it?
  4. Allow the government to negotiate for the prices of prescription drugs for Medicare, Medicaid, and federal employees. The government belongs to the taxpayers, and we have made it clear that Medicare is something we want to keep. So why can’t Medicare shop around for good prices?
  5. Revise the tax code to make non-profit health care systems that pay all employees (including physicians) attractive to those physicians and the executives that run them. Many people recognize that places like the Mayo Clinic and the Cleveland Clinic are centers of medical excellence; how many know that they are both low cost leaders as well?

Free-trade, fair competition, free markets, and tax cuts; sounds like a Republican bill to me. So why haven’t these points been codified by someone from red state America? The GOP has done an admirable job of manipulating parliamentary procedure to gum up the Congress, and they are about to cry wolf when the Democrats use procedure to go around them. My question is, why haven’t they used the time to propose meaningful legislation for the American people?

I think a bill featuring the above points would be a good measure, but it misses some opportunities. In the spirit of put up or shut up, I will use this space on Thursday to propose my own measure. The comment section is open to all who wish to jump into the fray.

The Rational Middle is listening…