JONATHAN COHN NOVEMBER 21, 2011
-
Read Later
READ LATERAvailable only to subscribers. SUBSCRIBE TODAY
-
Listen
ARTICLE AUDIO
- Font Size
On Friday I did something I almost never do: I tuned into Rush Limbaugh. And wouldn’t you know it? He was talking about one of my favorite subjects: Mitt Romney and health care reform.
Limbaugh was explaining why conservatives have such a hard time with Romney. It’s not that Romney lacks appealing qualities: On the contrary, Limbaugh described Romney “as a fine person … as nice a guy as you would ever run into.” The problem, Limbaugh said, was Romney’s refusal to apologize for signing a universal health care law in Massachusetts.
It’d be one thing, Limbaugh suggested, if Romney had expressed regret for signing that law. But Romney continues to stand by the Massachusetts law, including the dreaded individual mandate – the requirement that everybody with the means to pay for health care either obtain insurance or pay a fee to the government.
Romney’s only nod to conservatives is that he wouldn’t impose the law nationally, the way President Obama did when he signed the Affordable Care Act. According to Limbaugh, that’s not cutting it with conservatives: “That's why the polling data is what it is because people are troubled by his steadfast glue that keeps him attached to Romneycare, people don't like it because they do think it's much the same thing as Obamacare.”
I suspect Limbaugh is right about this. Many conservatives simply can’t get over Romney’s sponsorship of an individual mandate. But it also got me wondering about something else. Suppose health care reform, both the Massachusetts version and then the national version, included no mandate. Would Limbaugh and the rest of the right wing be happy? I doubt it.
Stop and think for a moment what universal health care entails. Unless you're willing to enact a single-payer plan -- which would be fine with me, but probably not Rush -- you have to regulate insurance companies pretty heavily. Among other things, you have to prohibit insurers from denying coverage to or raising premiums for people with pre-existing conditions.
In addition, you have to provide subsidies to lower- and middle-income Americans, so they have enough money to pay for their insurance, or you have to expand government programs for the poor, like Medicaid. That isn't cheap.
The Affordable Care Act calls for a little less than $1 trillion of spending on subsidies and Medicaid expansion in the first ten years. The law pays for that, in part, by imposing new taxes on the very wealthy and by taking some money away from the health care industry.
In other words, universal health care requires a lot of regulation and redistribution. Last time I checked, Limbaugh hates these things. So do his listeners.
And that's not all. If you want health care reform to reduce the cost of health care, as you should, then you also need to start changing the way we deliver medical care in this country.
Romneycare actually didn’t do this (although Massachusetts lawmakers are trying now) but Obamacare did – partly by cutting payments to private insurers that work with Medicare and partly by changing the financial incentives, in public and private insurance, that rewarded quantity over quality. I'm pretty sure Limbaugh hate these changes, as well. I know other conservatives do.
Just to be clear, I'm not suggesting the individual mandate is irrelevant, as policy or as politics. If nothing else, it's given conservatives an easy and useful target, because it's the one part of health care reform most people understand.
But don’t be fooled. The primary reason Limbaugh and his listeners don't like universal health care is that they reject the basic concept. They simply don't believe in using government to make sure every American has access to affordable health care.
13 comments
You have to move to Germany to have "access to affordable health care". ACA is about "access to health care insurance". Just like Massachusetts, the cost savings are like unicorns - we belive they are real, but no one has yet to see one. Medicare distorts the entire cost structure, and there seems to be favoritism in payments for any provider using a technology supplied by General Electric. Reimbursement for MRIs are very generous. Give it a rest. The Dems will lose if 2012 is a referendum on Obamacare.
- K2K
November 21, 2011 at 1:13am
Good to see you toeing the Norquist line on cost savings, K2K. It's a good point, though: why try to do something difficult like slowing the growth of health care costs, when you can just mouth off and do nothing, instead?
- Curran1
November 21, 2011 at 6:37am
Health care is a profoundly moral issue. If one side in the debate would find it acceptable that money alone determines who shall live...
- paskunac
November 21, 2011 at 7:36am
I think Jonathan only digs down one layer and at the rock level is the conservative principle that government should wage war and get out of the way of business and nothing else. It's like a farmer who says that his role is to get out of the way of nature, which is fine if your crop is just weeds.
- Nusholtz
November 21, 2011 at 7:45am
"It's like a farmer who says that his role is to get out of the way of nature" Absolutely one of the very best analogies (in reductio ad absurdam, anyway) I've ever heard. Props, Nush.
- Tristan
November 21, 2011 at 8:54am
Thank, Jonathan, for bringing us back to the basics. This should become a question in the next debate on the economy that the Republicans have. I doubt that will happen, but it sure as heck should be discussed in the actual presidential debates ... what healthcare problems do you believe we should we solve?
- NR409654
November 21, 2011 at 9:26am
What Cohn does here is equate health care reform with universal health insurance coverage (rather than with guaranteed coverage for those with pre-existing conditions), so he says that, even without a mandate, "you have to provide subsidies to lower- and middle-income Americans, so they have enough money to pay for their insurance, or you have to expand government programs for the poor, like Medicaid." Those who read the comments know that I don't necessarily agree that guaranteed coverage requires universal coverage (and the new government entitlement that comes with it); but whether the insurers could have responded to guaranteed coverage without the government delivering all those young and healthy insureds (with the premiums being paid by the new entitlement) is academic, because neither those who opposed HCR nor those who supported it will ever let us find out.
- rayward
November 21, 2011 at 10:03am
Curran: I want a targeted drone strike on Norquist, so I have no idea what you think I have in common with him. My comment was solely based on my increasingly traumatic experience with Medicare since 2007 - blood tests are reimbursed near zero, but an MRI gets paid for far more than it is worth. I spend time in Massachusetts, and have yet to meet anyone who does not complain about their higher premiums & co-pays and longer wait times for specialists since Romneycare, which was meant to provide access to health insurance for the 8% of residents who were un-insured, without addressing cost - that was supposed to come later, and later has arrived in 2011. I continue to believe that a far better reform would have STARTED with 1) dealing with med school tuition to favor primay care, 2) expand nurse-practitioners, 3) expand community clinics, 4) real effort to make "best practices" easier to adopt, 5) re-think med school so new doctors are not legal drug dealers. Medication side effects are a huge reason why people get sick, but Big Pharma rules, and 6) de-link health care insurance from employment. In 1992, my employer offered Long Term Care Insurance, and it was portable. I have maintained that coverage since that employer downsized me in 1996, although now that i know only 3% of Americans carry LTC, am beginning to question why I should be personally responsible when 97%is gaming Medicaid for LTC. However, the GOP is insane when they claim that consumers can "shop" for the best deal. In 2005, I needed knee surgery. I was already on Medicare. No one in that surgeon's office would even answer my question as to the starting price for entering the OR, so I could decide if I could afford the co-pay. So, I passed, and physical therapy alone worked, just as Medicare was reducing access for physical therapy.
- K2K
November 21, 2011 at 12:23pm
Thank you, Tristan
- Nusholtz
November 21, 2011 at 12:29pm
K2K, my apologies, and my sympathies for your situation. I wish the average voter thought as much about health care reform as you do.
- Curran1
November 21, 2011 at 1:01pm
nush, but I have field few of weed and I am making a killing selling it in California....oh wait, did you say weeds? Ooops. Never mind. K2K: 1) dealing with med school tuition to favor primary care, (a number of institutions will do tuition re-imbursement for a commitment of time) 2) expand nurse-practitioners, (my sister in law in a NP and this field is rapidly expanding right now) 3) expand community clinics, (it would be nice if not for the states closing them down, at least PA had it expanded a great deal) 4) real effort to make "best practices" easier to adopt, (what does this even mean?) 5) re-think med school so new doctors are not legal drug dealers. Medication side effects are a huge reason why people get sick, but Big Pharma rules, and (I am sorry but wtf? yes med side effects cause harm but that is what clinical trials are for, but without a doubt it has been medication that has led to the greatest increase in life expectancy since the dawn of mankind. Yes, Doctors overprescribe, but guess what, doctors are people and when parents come in with a bawling infant that has a viral cold doctors will prescribe something even though it is of limited utility because the patients demand it) 6) de-link health care insurance from employment. (Obama is starting to do this with health insurance exchanges and premium support)
- blackton
November 21, 2011 at 2:21pm
Thank you Curran. I have a lot of experience with the health care system - I joke in a sarcastic way that I am the product of some of the best (as in highly rated, even famous) doctors in the NYC metro area when I had the best employer-supplied health insurance. So, I do not see the answer as access to health care INSURANCE, but changing the way medicine is PRACTICED in the USA. I have one specialist from 1978 who has become a big-deal doctor - and he is the only doctor who has never done harm, and always helped. Ear, nose, throat. Last year, I asked him to remove an annoying skin growth that decided to grow exactly where my eyeglass nose pad sits. (My dermatologist hates Medicare patients, and his nurse suggested I ask my ENT Dr because it was on my nose) He had to do it outpatient where he teaches. He arranged, without my knowledge, for two residents to come in and listen to two of my better examples of medication mistakes. And, he never billed Medicare, nor did the hospital. He grabbed the forms from the admin, and I guess he wrote it off as "training". blackton: I have no citations for some of the studies I have read about "best practices", but it is fascinating to compare different approaches. I think one was in Camden, NJ, one of the poorest cities in the US. About medication side effects? Doctors often prescribe a second RX to deal with side effects from the first one. Not always because the patient asks for a med. I have numerous stories, and also witnessed what happened to one 10th grader over the semester I had her in class. By the fifth layer of med, she had to leave school, and it was so sad to know that she was not being listened to, except by me and one of her classmates. I do not know why so many doctors refuse to accept herbal effectiveness. After all, the active ingredient in Bayer's original and current aspirin is a synthetic ingredient originally derived from White Willow Bark. When you compound the effect of antibiotics in American beef, chicken, and eggs, it is no wonder that health care costs are so high. Nice it has gotten so much easier to find sources that are antibiotic-free. Effective herbal treatments: ginger works as well for acid reflux as it does for nausea; Raw garlic is a natural antibiotic and I cured near pneumonia-bronchitis with it last year because I can not risk taking antibiotics anymore. And, one clove of raw garlic will bring my blood sugar to normal in thirty minutes. One ounce of 100% cocoa (for baking) daily is an effective anti-depressant. Thyme is excellent from bronchial relief. Chapparal (larrea mexicana aka creosote bush from the desert SW) is outstanding for hornet and bee stings, healing blisters, scratches, and new surgical scars, but the FDA regulates Chapparral so that people do not ingest the tea (which kills HPV), so my source is my secret. Pau D'Arco is a powerful anti-viral. I am Big Pharma's worst nightmare, but that is because a major medication mistake in 2002 from a very famous Princeton doctor led to a rare, life-threatening side effect that means I can no longer take most modern medicines, which also have same rare side effect. so, blackton, next time your infant gets a cold or virus, or even an ear infection, try Pau D'Arco, and find a way to add chopped raw garlic into some mashed potatoes.
- K2K
November 21, 2011 at 6:17pm
K2K , The ACA is a good start on the road to all of the health care system reforms you mentioned . It at least has provisions that have the promise of reforming fee for service medicines and has the much maligned panel of experts to recommened effective ( best ) practices. No doubt , when you bring more insured patients into the system , the wait times for all physicians will increase . The Stimulus package put a fair amount of $ into increasing the number of community clinics .
- alanwilkov
November 22, 2011 at 12:34am