Barbarians at the Gate: The GOP's Health Reform Plan

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Frederick Bass / fstop / Corbis

The U.S. Capitol, Washington, D.C.

I had a bit of surgery last week. It wasn't much — the kind of outpatient operation that would once have had me hospitalized for three or four days, but with new, less invasive procedures, had me in and out in five hours. When I arrived home, my daughters (ages 7 and 9) met me at the door dressed in doctor outfits — a sweet welcome that made me smile. Before they provided me any make-believe care, however, the 7-year-old handed me a sheaf of homemade forms and said, "Please, sign these." I'm not making this up.

My daughters are too young to know anything but a health care industry in which no visit to a doctor's office can begin without a flurry of forms, a question about your health insurance and the ritual xeroxing of your card for safekeeping. Much of this — though certainly not all — is a result of our nation's patchwork of coverage and plans as well as our lack of a coherent system of electronic medical records.

But my daughters — and everyone else's sons and daughters — are at least growing up in an era in which a real (and admittedly imperfect) step had been taken toward changing things, with the signing of President Obama's signature health-reform law six months ago. That's why it was so dispiriting to read Tuesday's front-page story in the New York Times about Republican plans to dismantle the law if they take control of Congress in November.

No matter how bad the coming Democratic bloodbath is or isn't (and columnist Charles Blow, also of the Times, made a thoughtful if thin argument on Sunday that it may not be quite so ugly as nervous Dems fear), Republicans will still have plenty of ways to inflict a thousand cuts on health reform if they win even a single chamber. They could gum up funding needed to enforce the law; they could try to strip out the requirement that employers offer employees insurance or pay a penalty for not doing so; they could go after the same thing the attorneys general of 20 states are seeking to overturn in the courts: the requirement that individuals obtain insurance or also pay a fine.

The warnings from the GOP's shadow majority come at an apt — if, for them, unhandy — time. Just last week, the U.S. Census announced that the number of uninsured Americans crossed the 50 million threshold for the first time — many of those people having lost their jobs in the economic meltdown. The new law, whose requirements are being phased in over several years, is designed to prevent the loss of a job from equaling the loss of insurance. It is also designed to prevent people from being dropped from coverage because they get sick and being denied coverage due to a pre-existing condition, and it eliminates lifetime caps. Additionally, it allows kids to stay on their parents' policies until they're 26 — especially important when young people are being hit hard by double-digit unemployment.

What's more, in just two months, people who do have jobs will be facing the annual ritual of open enrollment, trying to sort out the cost and benefits of various insurance plans offered by their employers and choosing the right one. Some of the most popular features of the reform law like the no-lifetime-limit rule will take effect in the new employee plans. Promising to undo those protections is not likely to make the current minority party the new majority.

The Republican response to this comes from the same all-dessert policy menu that produced the mathematical impossibility of lower taxes and higher federal revenue: we can cut unpopular provisions like the individual mandate while keeping the popular ones. But unless you agree with the Luo tribesman theory of Obama's leadership style put forward by Dinesh D'Souza in Forbes and endorsed by GOP ideas man Newt Gingrich, there's no earthly reason the President would have pressed for the mandate provision that so many people flatly despise unless it was impossible to make the numbers line up any other way.

Once again, for the 12 millionth time: if you don't require people to buy insurance, no one will bother to do so until they get sick, meaning that the insurance business becomes all risk, no profit. How's free-market coverage going to work then? The alternative to an individual mandate is simply to deny coverage to people who wait too long — otherwise known as the pre-existing-condition rule. Even in the GOP, few people are taking the position of once and perhaps future GOP presidential contender Mike Huckabee, who in a speech last week at the Values Voters Summit made his way through a metaphorical thicket to suggest that maybe the old denial because-you're-already-sick idea wasn't such a bad thing: "How would you like to be able to call your insurance agent for your car and say, 'I want you to insure my car.' 'Well, tell me about your car.' 'Well, it was a pretty nice vehicle until my 16-year-old boy wrecked it yesterday.' Now how much would a policy cost if it covered everything? About as much as it's gonna cost for health care in this country."

The difference — as Huckabee surely knows — is that you can't simply take your uninsured car into the auto equivalent of an emergency room and get it fixed on everybody else's dime, which you can do with your uninsured self in a humane country that wisely forbids ERs from turning people away. What's more, illness may sometimes be the result of carelessness — the equivalent of letting a 16-year-old drive — but just as often it's simply a roll of the dice.

A final bit of unexpected — and perhaps unintentionally sound — reasoning came on Fox News on Sept. 21, courtesy of host Greg Gutfeld. Citing statistics from economist Mark J. Perry, Gutfeld points out that 10.6 million uninsured Americans live in households making $75,000 per year or more and another 9.4 million uninsured are in the $50,000 to $75,000 range. His conclusion from this? "So while we've been constantly told that people cannot afford insurance, these numbers say otherwise. Some reject insurance by choice, maybe cuz they're self-insured or more likely to get their prescriptions at Walmart. But more to the point: the people I know who don't have health insurance don't care."

It's hard to know from Gutfeld's entire argument whether he's in favor of or opposes health reform. But putting aside his less than Churchillian "cuz" and his less than scientific sample group ("the people I know"), Gutfeld makes the reformers' point: When uninsured people do get sick, do you think they'll shrug, accept the fact that they placed the wrong bet and go off quietly to expire? Or do you think they might be the next ones at the ER door — driving up prices for everyone else? The only way everyone wins is if everyone plays.

It's naive to believe that with the current law — or any law — we'll ever be living in a health care utopia. We're still years away even from the time a 7-year-old pretending to be a doctor would hand her pretend patient a pretend iPad and say, "Touch if your electronic records are up to date," but at least we're moving there. We'd be wise to continue.