I noticed that Gov. Tim Pawlenty, one of at least 20 Republican Presidential hopefuls for 2012, recently allowed a five-point list of Republican health care proposals to be published under his name. It didn't attract a lot of attention, although it's intended as a presentation of ideas for the February 25 health care summit. It's nice to see any Republican attempting to be constructive, but it's starting to happen as candidates for office realize they've got to have some kind of platform.
Pawlenty's list isn't all bad. What he calls "incentivizing" health care consumers (No. 1 on the list), and "pay for performance" (No. 2) are both small steps toward the broader idea of consumer-driven care. Small, because real change in this direction would challenge the profit margins of GOP-client big businesses, hospitals, and medical groups. Is Pawlenty willing to tackle that? Still, as he says, Minnesota has a system aimed at making changes in this direction, and we should look at it.
Hardly anyone will be against "modernizing health insurance," (No. 5), by which he means portability, no discrimination against preexisting conditions, and health savings accounts. But it's not much of a contribution to the dialogue, since all this already exists in the Administration bill that Pawlenty's Elephantine Party members insist on jettisoning.
Liability reform (No. 3) is another idea that most health reformers agree could make a small contribution to reducing costs of health care. Obama has supported it though many Democrats in Congress have not. Question for Pawlenty and his party: If you want to argue that it's unconstitutional for the federal government to require people to buy health insurance, isn't it also unconstitutional to impose limits on settlements that can be imposed in malpractice suits? I personally don't think either of these things is unconstitutional, but...
Finally, Item 4: "Interstate health care insurance." Here, I think, is the wolf in sheep's clothing. It sounds reasonable, as Pawlenty says, that there's no reason a Minnesotan shouldn't be able to buy insurance in another state. Well, except that insurance in the U.S. is regulated (if at all) by states. Some states have stronger consumer protections and higher requirements than others. Insurance companies often tend to avoid issuing policies in states where they can't meet the standard, meaning that "out-of-state" insurance usually means substandard quality. If Pawlenty means only that a Minnesotan should be able to buy insurance from any insurance company registered and approved by the Minnesota state insurance authorities, I suspect that's already the case (it is in most states). If he means they should go buy it anywhere, that's a problem, as Ezra Klein explains in detail here. It's kind of like going to have your car's brakes fixed in Mexico; it's likely to be a chance you don't want to take.
Overall, Pawlenty deserves credit for at least putting some ideas on the table. He's shown some political courage in proposing two ideas that could lead to real innovation but which are opposed by most Republicans. Two other proposals are already a part of the Obama plan, leaving only one that's a terrible idea. So the question arises, as the old lady used to say, "Where's the beef?" Why couldn't we have heard these ideas earlier from Republicans; was it really worth the wait for such thin gruel; and by the way, where in Pawlenty's proposals are the Republican ideas for reducing costs NOW of existing care (especially Medicare)? Liability reform won't cut it.
Comments