In a way, it's a shame Mitt Romney dropped out of the presidential race so soon, as he was the candidate who could speak with the most authority about the realities facing any president trying to establish universal health insurance. The former governor has first-hand experience with that overwhelming economic challenge, as well as the political scars to prove it. In fact, he even has some good ideas for an alternative to a national program.
Yes, we all know that Sen. Hillary Clinton, while First Lady, took on the crusade to reform our dysfunctional health care system. The insurance industry, through its ingenious "Harry and Louise" ads, torpedoed her vast proposal, which was concocted in secret sessions, before it had a chance to gather any political momentum.
Mr. Romney, as governor of Massachusetts, actually signed a sweeping health insurance reform measure into law, designed to cover all residents. Indeed, the program includes the same mandate to buy coverage (with penalties imposed on violators) called for by Sen. Clinton, but rejected by Sen. Barack Obama (who would mandate coverage only for children).
As reported in the Aug. 24, 2007, New York Times (click here to read the entire article), the universal health insurance plan, which took effect last year, was "Mr. Romney’s signal legislative accomplishment as governor," but the problem is that it's coming up short on cash.
As I noted in my Feb. 1 blog--"Is Health Care Reform Doomed?"--the state announced that the program was underfunded by about $245 million in this fiscal year, and would require an additional $400 million next year to cover costs.
That scared the life out of California lawmakers, prompting the Senate Health Committee to defeat a reform proposal similar to the one in Massachusetts, supported strongly by Republican Gov. Arnold Schwarzenegger, by a decisive 7-to-1 vote.
I had no love for Mr. Romney as a candidate. But I wished he had the chance to debate one of the Democratic candidates on health care reform, since he knows how the best laid plans to cover the uninsured can go awry.
For Mr. Romney, the problem is far from academic. Rather than debate in a vacuum, I would have liked to have heard him go head to head with either senator--Clinton or Obama--to force them to explain how their national, universal plans would turn out differently.
To be fair, the Democratic candidates say the problem in Massachusetts and the failure to pass a bill in California does not mean universal health insurance is a pipe dream. Instead, they argue that it proves the issue cannot be handled on a state-by-state basis. Only a truly national system will do the trick, they contend. I'd like to hear more on how and why.
In the meantime, Mr. Romney had some interesting ideas on how to get affordable policies to the uninsured without establishing a national system or mandating coverage.
According to the Times story, Mr. Romney "argues that the existing tax system penalizes those who do not acquire their health insurance through their employer, and that has prevented the development of a vigorous, affordable health insurance market. Those who acquire health insurance from their employers pay for their premiums with pre-tax dollars, but those who do not must use post-tax dollars to buy it. So Mr. Romney wants to allow people who buy their own health insurance to be able to deduct premiums, deductibles and co-payments from their income."
Mr. Romney also wanted to offer "incentives to states to take their own necessary steps to bring down the cost of health insurance," the Times reported.
Mr. Romeny split the 45 or so million uninsured into three groups, according to the Times--"about a third are eligible for public programs but are not enrolled; a third are low income but ineligible for public programs and need some help from the government to purchase health insurance; a third are middle income but have chosen not to buy health insurance."
He proposed "taking federal money currently being used to help states cover the cost of medical care for the uninsured and offering that money to states to help low-income people who are not eligible for Medicaid and other public programs to buy their own private health insurance," the Times reported.
Actually, this sounds intriguing. It's at least worth talking about before creating a new federal entitlement program. But now that Mr. Romney is out of the race, his ideas might disappear with his failed candidacy.
That is, unless he becomes Sen. McCain's running mate--although I don't think that's likely. In fact, my fear is that to pander to the religious right, McCain will ask Mike Huckabee to join the ticket, leaving open the possibility of having a former minister who doesn't believe in evolution (or the IRS, for that matter) as the vice president to a 72-year-old chief executive.
At the very least, perhaps McCain can appropriate Romney's health care reform plan as his own. At least that way he wouldn't go against a Democrat promising universal coverage by saying, 'Let's stick with the failed system we have and hope for the best.'
What do you folks think of Mr. Romeny's health care reform suggestions?
Comments (4)
I thought you mind find the statistics I've put together on the so-called uninsured interesting. You can see them on my Web site, www.politicalsunshine.com.
The oft-quoted number of over 40 million uninsured includes everybody who is uninsured. That includes wealthy people who self-insure, young adults who choose to take the risk, people temporarily in-between jobs, people eligible for government programs that are not aware of it AND the children of all of these people.
My own estimate is that the number of people who want but cannot obtain insurance could be half of the gross number reported. . . still a problem but not nearly as big.
My new site goes to the source of these statistics and others, and presents them in an easy-to-read format and provides some interpretation without taking political sides.
Check it out and check back for new data as I develop it.
One area you might be interested in are statistics on the efficacy of drugs and medical procedures. I plan to publish easy-to-understand data on statin efficacy soon as the first data set in this topic.
Posted by Jeffrey Lapides | February 7, 2008 11:06 PM
Posted on February 7, 2008 23:06
The only way we are going to see "Health Care Reform" is to abolish the term.
"Health Care Reform" is too broad and vague. It consists of legal reform, paperwork and administration reform, employer benefits reform, social reform (when is it okay to let someone die?), pricing reform (they should be posted so people can shop around). Each one of these reforms will make someone unhappy.
Howvever, if we reform one piece at a time, the bites will be small enough to swallow. That was Hillary's problem.
Posted by Greg | February 8, 2008 1:44 PM
Posted on February 8, 2008 13:44
We will not be able to stop the movement to a national health care system until our industry takes a hard look in the mirror at our own contribution to the problem.
During my long insurance industry career, like my colleagues, I have been a strong opponent of a national system--until recently.
A few years ago I formed my own small firm with 20 professional consultants. Since then we have been confronted with annual double-digit health insurance rate increases, even though it is a relatively young group with low claim experience.
Last year, to avoid another 12% increase, we shifted to an HRA with a $4,000 deductible that we reimburse to our employees. We had negligible excess claims reported to the insurer.
So what did we get in the mail the other day? Another 12% rate increase.
I ask the question, what has my insurer done for me in the past few years to make our insurance more affordable? Has it fought escalating drug costs with our Pharma friends? Has it funded any research into alternative, lower cost treatment regimens? I don't think so.
But we have spent a good deal to lobby against reform with no solutions except double-digit rate increases tied to reduced benefits.
Just what effective reform alternatives have we heard from our industry as I raise our deductible to $5,000 this year to lower that double digit increase?
"Mirror, mirror on the wall..."
Posted by Frank Cacchione | February 9, 2008 7:39 AM
Posted on February 9, 2008 07:39
I like the fact that they keep referring to the one-third who "choose" not to purchase insurance. For most of these people it is not a choice--they simply cannot afford it.
Many people who are offered insurance through their employer also cannot afford it. We happen to carry insurance through my husband's employer--good coverage and reasonably priced, but that it not the option for many people.
Before we talk about national reform, we do need to look at each individual component.
The pricing structure needs to be addressed first. Many hospitals and doctors subsidize the unisured losses through those that do have insurance.
A good example: A few years ago, I was involved in an accident. The screws in my leg were $2,000 a piece and I have 8 of them! I'm pretty sure that they could be made for a whole lot less than that.
Prescription drugs is another area that should be scrutinized. I just picked up some medicines last week at the pharmacy. If I didn't have insurance, they would have cost me $1,006. I only paid $32.
I realize that research needs to be funded, but maybe generics need to be allowed to market sooner than they currently are, or research be funded by the government instead of the drug companies.
I do agree that this needs to be addressed at the national level, instead of on a state-by-state basis. Unfortunately, no one will sit down and explain a step-by-step plan, exactly what they hope to accomplish, and how it will be paid for.
Posted by Cheri Olson, CPCU | February 11, 2008 10:56 AM
Posted on February 11, 2008 10:56