We’ve been warned. (1) We’ve known since the days of astro-turfed Tea Party assaults on Congressional home town sessions that the Republicans had a game plan for making health insurance reform a marker in their campaigns. (2) We’ve known since the beginning that the insurance industry and their political action committee partners were pouring tons of money into opposition to health insurance reform. And, (3) Stanley Tucci’s character in The Devil Wears Prada (2006) gave us our opening line: “All right everybody, gird your loins.” We can make another list of things we know.
#1. The Republicans have lied and will continue to lie about the contents of the statute. A sample:
“Obamacare cuts Medicare,” is factually inaccurate. Politifact reports: “The legislation aims to slow projected spending on Medicare by more than $500 billion over a 10-year period, but it does not cut that money from the program. Medicare spending will increase over that time frame.”
“Obamacare is a $500 billion tax increase,” is factually inaccurate. The tax increase to which Governor Romney is referring is an amalgamation of every excise contained in the bill, whether the tax affects industries or individuals. There is, for example an excise associated with the so-called Cadillac Health Plans, insurance plans which because of their cost are unavailable to most Americans. Health insurance corporations are taxed. Medical equipment manufacturers are taxes — BUT the GOP has, and will continue to make it sound as though these taxes will be paid by “you” the ordinary American middle class person. This is highly misleading.
#2. The Republicans will attempt to change the language of the debate. Privatizing Medicare will be called a “free market solution.” Advocating that people are on their own when it comes to dealing with the behemoth health insurance corporations will be called “individual choice.” No matter how deftly the language is phrased the intent is the same: You’re On Your Own.
#3. Republicans will speak in generalities. They will not address the issues that illustrate why health insurance reform is necessary. They will speak of “freedom of choice,” without noting that for families in which a child has a pre-existing medical condition there may be no health insurance available from any source. They will speak of “individual responsibility,” without a nod toward the fact that some families were facing the prospect that an elderly parent would have to be institutionally cared for rather than be assisted by home or community health services.
One slightly new wrinkle in Governor Romney’s presentation is a declaration that we should not “discriminate against the individual purchase of insurance.” While this makes a lovely sound bite we are left to our own imaginations to figure out what this might mean. Does it mean tax deductions for Cadillac Health Plans owned by those in the upper income brackets? We’ll see this element in the next section, and in the commentary on Governor Romney’s current “plan.”
#4. Republicans will offer nothing new.* In fact, what they are offering is relatively nothing more than the talking points they issued in 1993-1994 to oppose “HillaryCare.” What they wanted then were Chamber of Commerce based small business insurance pools. Hardly a national response to a national problem. They wanted tax-deductible health insurance premiums. Not really a solution for those who can’t afford to pay up front for the health insurance in the first place. Further, the more expensive the health care plan the more “deductions” or tax credits — not something which has the interests of those who can’t even find affordable insurance in mind. However, the 1% would find this a very agreeable deduction.
They wanted “tax credits” or “vouchers” for low income Americans, as if the low income Americans could afford health insurance plans, and as if the “vouchers” weren’t a form of subsidy for the health insurance corporations.
Back in 1994 they wanted the establishment of health savings accounts, which as has been pointed out during the last two decades are really good for the young and healthy, but not very useful for anyone else EXCEPT the Wall Street bankers who get to re-invest the funds in the Wall Street Casino. “Banks and others are drawn by the promise of lucrative fees they can generate by offering consumers mutual funds and other investment vehicles as their account balances grow. Most also charge $50 to $75 to set up a health savings account, and they collect perhaps $40 or more each year in maintenance charges and service fees. Not since the creation of the individual retirement account in the mid-1970’s has such a potentially huge mountain of money landed in the lap of the financial services industry.” [NYT] (January 2006)
One of the major features of the 1994 GOP assault on health insurance reform was “malpractice reform.” Although medical malpractice cases are a miniscule portion of total health care costs in the United States of America. In fact, “…In 2004, the CBO calculated malpractice costs amounted to “less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small.” [AAJ] (emphasis added)
The old assault talking points called for limiting pre-existing conditions verbiage in employer based health insurance plans. Nothing about individually owned plans for the self employed? *(For more on the revamping of the GOP’s 1994 Talking Points see John Perr’s post.)
#5. The Romney/GOP health care “reform” for 2012 centers around tax deductions, and is not focused on expanding health care insurance coverage. As noted above, giving tax deductions for insurance purchases has been a crucial element in GOP insurance ‘reform’ since 1994.
“One of Mr. Romney’s chief proposals could shake up how the vast majority of Americans get health care — through employers. He would give a tax break to people who buy insurance individually on the open market, so they would enjoy the same advantage as workers who get insurance as a benefit at work, which is not taxed as income.” [NYT]
There are some issues with this, and some obvious questions. For example, if the major focus is on promoting individually purchased insurance plans, then is this not an incentive for employers to drop group insurance plans? While this might be dulcet musical tones to the ears of private equity firms seeking to pare down corporate expenses in their acquisitions, does it not also create a problem for workers who are dropped from the group plans? What does the Romney plan do to assure workers that there will be affordable health insurance plans available for a family of four? A family in which one member has a pre-existing health issue? A family in which the mother is pregnant?
What, in the Romney proposal, would restrain a health insurance corporation from raising premium costs to the ceiling and stars above while telling customers, “Don’t worry, it’s going to be tax deductible in April?” Even if individual and small group premium costs are expect to increase in the near future by an estimated 6% to 20%. [KFF]
Finally, we should gird our loins knowing full well the Republican Party has no real health insurance reform plan in the offing. They will promote “individual choice,” even when in many parts of the country there are no competitors for health plan sales. They will promote “tax deductions,” while ignoring the fact that they are loath to restrain the cost of individually procured health insurance policies. They will promote “individual purchased” plans thus allowing corporations to drop employer sponsored group plans to enhance “shareholder value,” and they will do nothing for small businesses which want to offer group plans except to encourage them not to do so.
For additional information see: John Perr, Republicans Push Twenty Year Old Plan, DKos, June 28, 2012. Gabriel & Pear, Parsing Romney, New York Times, June 29, 2012. Eric Dash, Health Savings Accounts, New York Times, January 27, 2006. American Association For Justice, Malpractice a Tiny Percentage of Health Care Costs. Ezra Klein, Romney’s Bogus Attack on the Affordable Care Act, Washington Post, June 29, 2012. Kaiser Family Foundation, Survey of Health Insurance Agents in Individual and Small Group Markets, June 15, 2012 (pdf) Karen Davis, The Commonwealth Fund, What’s Working to Control Costs? Ethan Rome, HCAN, Obamacare Repeal: Phase One of the Republican Assault on the Middle Class.