Takeover or Makeover

The Republicans say they have a health-care plan, one the American people can accept. It preserves the system we have, they insist, and brings down the cost of insurance. According to Representative Eric Cantor (R-Va.), the President's planis a "repackaged" version of the Senate Bill and, therefore,a "nonstarter"; the American people have already rejected the Democrats' proposal and so there's no point in pursuing it.

The New Republic's Jonathan Cohn, one of the shrewdest journalists on the health-care beat, takes another look at this "Republican plan" (which not all Republican lawmakers support) and reminds us of its basic inadequacy. Yes, the Congressional Budget Office forecasts that it would bring down theaverage insurance premium, butt he CBO also notes that it would do little to extend coverage to the uninsured and would bring down premiums only by allowing insurance providers to raise copayments and cover fewer services. Premiums would actually go up for those with serious illnesses; they would go down only for those who don't (now) need much health care. Insurers would be enabled to further shrink and purify their risk pools into little ponds of youth and good health. If one state's regulations kept them from doing this, they could simply relocate to a more accomodating state—and continue selling policies to people in the first state. Problem solved, for those who now have insurance and are relatively healthy.

But if you are not content just to bring down premiums for the young and healthy, if you also want to bring down the cost of medical services, extend insurance coverage to those who now lack it (including the sick and not-so-young), and protect people from being dropped by their insurers as soon as they become seriously, expensively ill, then you must do one of two things: either scrap the complicated system we have and replace it with a single-payer system (a government takeover worthy of the name), or strengthen regulations for the current system, so that it covers as many people as possible, as cheaply as possible, and then fill in whatever gaps are left with public programs (call it a private-insurance makeover).

Takeover or makeover: those are the options. The Democrats have adopted the latter, less radical approach. The Republicans have answered "Neither of the above" and reformulated the problem so that it will accomodate their ideologically determined solution. If making sure everyone has health insurance requires government intervention, they say, then it can't be that important because, as we all know, government intervention is almost always bad. They—or most of them—say they, too, are in favor of cracking down on insurance companies who dump sick policyholders. But the only way to make sure insurance companies can afford to cover those who need expensive treatment is to require that everyone, including the healthy, have insurance; and you can't do that without subsidizing insurance for those who couldn't otherwise afford it. To which the Republicans answer...have we mentioned the deficit? The unemployment rate?

If you are young and healthy and brave, do take a moment to watch the short video clip at the top of Cohn's post: it shows Cantor, the House Republicanwhip, whistling through the emergency room.

Matthew Boudway is senior editor of Commonweal.

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