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Conservatives Out of Touch On Health Care

2 years ago
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Jill Lawrence
Jill Lawrence
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Everyone is pro-choice when it comes to health care, but some conservatives don't understand what that means in the real world.
They argue that Democratic plans for health reform will rob people of choices. Somehow they have missed the fact that choices for most people are limited – sometimes severely -- right now.
A few months ago, I listened to Eric Cantor of Virginia, the second-ranking Republican in the House leadership, talk earnestly about preserving health choices for a hard-pressed single mother trying to support her kids.
Where does that woman live? I wondered. Here in Washington, D.C., many pediatricians don't take any insurance. Our internist dropped out of all health plans many years ago. My (former) gynecologist followed suit two years ago.
We know we're not alone. A regular feature of our neighborhood listserv is people asking for information about doctors. Their usual doctor has dropped out of their plan or all plans, or their company has dropped the plan that included their doctor.
And this is just the most benign manifestation of current limitations on choice – affluent urbanites wandering from doctor to doctor, or paying full freight to stay where they are.
Far more serious are the limited options available to people who are uninsured because they are between jobs, can't afford coverage or can't get it because they have pre-existing health problems. Some people have policies that don't cover maternity or mental health care, or won't pay for doctor visits until they've first gone to the hospital. And some people are facing financial ruin because their policies have huge deductibles or limits on treatments such as radiation or chemotherapy.
If you are lucky enough to have a policy through work, your employer dictates your choices. Or choice, singular. A Kaiser Family Foundation survey last year found that 85 percent of employers that provide health insurance offer only one type of plan.
President Obama campaigned last year on overhauling the health care system, and the Senate Finance Committee hopes to produce a bill next month. The goals are to expand coverage, improve care, and save money all at the same time. Major unresolved issues include whether to require everyone to buy insurance, whether to create a public health plan to compete with private insurance, and how to pay for the reforms.
For now the work in the Senate is bipartisan. But at the same time, the two parties are mobilizing for a rhetorical battle over who will expand choices and who will take them away.
Republican strategist Frank Luntz, in a memo to Republicans, says they should refer to Democratic plans as a "Washington takeover" that will shift choices from patients and doctors to politicians and bureaucrats. "Takeovers are like coups – they both lead to dictators and a loss of freedom," Luntz writes.
Luntz offers several definitions of a health care crisis, including when "some bureaucrat puts himself between you and your doctor, denying you exactly what you need." This never happens now, right? Wrong. The only difference is that he's talking about a government bureaucrat instead of an insurance company bureaucrat.
Same with Luntz's recommendation that conservatives raise the specter of politicians making health care decisions. "THEY decide if you'll get the procedure you need, or if you are disqualified because the treatment is too expensive or because you are too old." But don't insurance companies make those decisions now?
Anyone who has dealt with insurance companies, or has had to change doctors every year, will wonder what Luntz means when he says the top GOP priority must be to "protect the sacred doctor-patient relationship, and allow people to choose the personal care that suits their individual needs."
In an impassioned response to Luntz, Democratic consultant Paul Begala urges Democrats to stress that their plan "will protect that classic American right: the right to choose. You will be able to choose your doctor and choose your plan."
A central element of Obama's proposal is that if people like the plan they have now, they can keep it. That's a choice.
Far more controversial is the public option, a government-run insurance plan intended to spur better, cheaper private plans. It would be available to anyone who wants or needs it. "So if you get fed up" with private insurance, Begala writes, "you've got somewhere to go."
That sounds like more choice, not less. To many Republicans, however, it sounds like too much government.
Kaiser vice president Gary Claxton says tens of millions of people would have more choices under a revamped system. Among them are those whom insurance companies won't insure because they are already sick. They'd be eligible for coverage from a public plan. They might even be able to break into the private market. The insurance industry has offered to cover them in exchange for a government requirement that everyone, healthy and sick, buy insurance.
Low-income people like Cantor's apocryphal single mom also stand to gain more choice because any health reform package will have "pots of money" for premium subsidies, Claxton says. "A lot of people who are struggling to buy insurance that's not very good will be able to buy better insurance," he says.
The subsidies will also be a boon to low-income people who now have no coverage at all. And there are lots of them. Kaiser research shows that of the country's approximately 45 million uninsured, 29 million had incomes equivalent to less than $42,000 for a family of four.
So what about my relatively niggling concern about doctors who drop off plans or don't take insurance?
It is apparently an urban problem. Close to 25 percent of primary care doctors in Los Angeles did not participate in managed care plans in 2004-2005, the most recent data available from the Center for Studying Health System Change. The same was true of about 20 percent of specialists in New York and 15 percent of both types of doctors in Washington.
An estimated 11.5 percent of doctors across the country did not participate in the plans, up from 9.2 percent in 2000-2001. That's not an exodus, the center says, but it is significant and reflects doctors' "increasing frustration" over administrative burdens and low reimbursement rates.
The insurance industry, facing the prospect of changes that could include competition from a public plan, is now offering to standardize and streamline its administrative procedures. That could lead some doctors to stay in plans rather than throw up their hands and quit.
And that means more choices for patients.
Filed Under: Health Care
Tagged: health care, health care reform, health insurance, HealthCare, HealthCareReform, HealthInsurance
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