Wednesday, April 25, 2012

RomneyCare: Par For The Course

Caption: No, that's not Mitt Romney, that's Micheal Moore. The rubber glove seems appropriate, though.

It's hard to believe, but if the Los Angeles Times analysis is correct, Mitt Romney may have come up with a worse health care plan than President Obama and the Democrats did. Talking Points Memo summarizes:

What the Times arrived at is a plan broadly similar to the widely derided blueprint John McCain ran on in 2008.

The underlying idea is to wipe out one of the main fiscal tent poles of the existing health care system [tax breaks for employer-provided health care], and use the resulting revenues to finance billions of dollars in subsidies to buy insurance on the existing private market. The result, according to experts, would likely be a significant increase in the number of uninsured Americans, in an economy where, for better or worse, employers would likely no longer provide their workers with health care coverage.

Romney Hints At Radical Health Care Reform Plan To Replace ‘Obamacare’

For those who don't have to buy their own health insurance, let me introduce you to the central idea of this situation:

It's you against the insurance companies. That means you will lose.

When a medium- or large-sized company buys health insurance from an insurance company, it has some power in that relationship. If it decides to change insurance plans, the insurance company will lose a significant amount of revenue. While the company is not as motivated as its employees, it still will want its insurance provider to actually provide coverage for its employees, so they aren't sick all the time or leaving for an employer with a better health plan. Individual buyers, on the other hand, have little to no power in that relationship.

Of course, as the LA Times notes, this is another case when the Free Market Pony will gallop to our rescue, according to the "experts":

Conservative healthcare experts offer several reasons for such a change. The main one is that the tax law needs to be revised to bring free-market competition to the healthcare system.

"It is absolutely essential if you are going to reform the health insurance market to change the tax treatment of health insurance," said Robert Moffit, a senior fellow at the Heritage Foundation. "It is the 800-pound gorilla in the healthcare debate."

Moreover, the current system effectively discriminates against Americans who do not get health benefits at work. They must buy coverage on their own and do not get the same tax break.

Romney's healthcare plan may be more revolutionary than Obama's

There are any number of things wrong with what these "experts" are saying, not the least of which is that health insurance is not, and will never be, a "free market". It is a risk pool, and that in itself says it's going to be rather less than free, because bigger risk pools are inherently safer. Since market forces are almost inevitably affected by costs, it pays to leave people out of those pools who actually need health care services. Leaving insurance companies to compete has gotten us where we are now - with people who need insurance not able to buy it or afford to use it.

Which is a long way of saying that the LA Times is right when it says this:

For example, if workers had the ability to shop anywhere for a health plan, and if companies no longer got tax breaks, some employers would likely stop providing health coverage. That might be fine for young, healthy workers who could buy plans on their own. But older or sicker workers would lose the protection they now receive by buying insurance within a group. If young adults opted to buy low-cost plans that provided limited benefits, prices could rise sharply for middle-aged workers who are more likely to have chronic health problems.

Under the [Presidential candidates John] McCain [health care reform] plan, more than 9 million fewer people would have received health benefits through their jobs, according to an estimate from the Lewin Group, a healthcare consulting firm.

Romney's healthcare plan may be more revolutionary than Obama's

There's little reason to doubt any of that analysis, assuming the Times is correct about Romney's intentions.

So, what about the individual mandate, perhaps the most unpopular notion in the Affordable Care Act (ACA), and certainly one I've objected to often enough? Don't get your hopes up. The LA Times notes that Romney pooh-poohed the mandate during the primary campaign, but I remain skeptical. Obama and the Democrats gave the insurance companies the chance to put millions of uncovered Americans over the fence and bone the daylights out of us. They won't give that up without expecting something else in return. With our two current political parties, the insurance companies get what they expect.

Ergo, if you're expecting "RomneyCare" to be mandate-free, you're even dumber than the folks who expected Obama and the Democrats would hold out for a "public option". After all, when he was on the campaign trail, Obama's health care plan didn't have a mandate, either.

RomneyCare will, if implemented, be a fitting successor to ObamaCare. ObamaCare managed to make things worse than they were already, and RomneyCare will make them worse still. It's sad, when the GOP could have put forward a plan to change the ACA that would have followed their stated principles, and yet improved the system at least slightly, that they have chosen not to do so.

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