What’s wrong with Republican healthcare plans?

What’s wrong with Republican healthcare plans? January 25, 2011

Answer: In terms of policy, they don’t cover many people and they are not very cost-effective. In terms of Catholic social teaching, they violate both solidarity (taking care of the less fortunate directly) and subsidiarity (removing impediments to furthering human dignity in the private domain). There are many different ideas floating around, often with little coherence between them, but they do share a common trait – the desire to move healthcare away from a communal to an individual concern. Just look at some of the common ideas – tax credits, ending tax breaks for employer-based insurance, encouraging high-deductible coverage, turning Medicare into a voucher scheme that moves away from guaranteed benefits. All of these ideas reward the young and healthy, while leaving those who need care the most in the lurch.

It is really an ideological position, based on the cult of individualism, the liberal sense of responsibility for one’s own destiny. There are a number of ways to achieve universal coverage. One is simply to subsidize it without any reforms, or to move toward an individual system and dish out subsidies. The problem is that this becomes incredibly expensive, unsustainably expensive, as the healthy are abandoning their responsibility to help those in need. The other way is to put everybody in a pool, the sick and the healthy, the young and the old, without discriminating. Many countries do this through a single-payers system, which cuts down on excess administrative complication. Other countries rely on private insurance, combining some form of community rating (no discrimination based on health status) with an individual mandate (making sure that the healthy simply don’t “go it alone” to reduce their costs). In a nutshell, this is what the Affordable Care Act does, aided by some subsidies for those on lower incomes.

Remember, this used to be a Republican idea. It was once the bedrock of Republican opposition to the more centralized approach of the Clintons. It was the approach taken by Romney in Massachusetts. But today, the crazy individualists call the shots. The problem is, when you start from this position, it becomes virtually impossible to reform healthcare. The Republicans seem to be finally understanding that circles can’t be squared, and are simply backing away from universal healthcare as a policy goal. Let’s be clear that this stands starkly against the tenets of Catholic social teaching. They can approach it from different angles, but they are not permitted to abandon it.

Let’s look at some of their plans. In 2009, the CBO evaluated the Republican plan, noting that it left 52 million still uninsured, and saved dramatically less money that the Democratic alternatives. The only good idea in this plan was tort reform – this doesn’t get you much, but it gets you something, and is worth considering. Or go back to the 2008 John McCain plan, based on tax credits, would cover fewer people and cost dramatically more (at least twice as much), while leaving much uncertainty over the quality of insurance.

Possibly the biggest talking point in Republican sources is the plan to let insurance companies compete across state lines. This feeds directly into ideological comfort zones about unleashing the wonder-working power of the free market, oblivious to the evident imperfections in the healthcare market. If it is the most popular position, it is also the most dangerous. Think about what this means. The individual market is completely dysfunctional, with massive discrimination based on health status. The quality of coverage is often pathetic, and lies behind the chronic problem of under-insurance that exists alongside uninsurance. And the fact that people with pre-existing conditions can get anything at all is usually due to state-level regulations. What would happen if the Republican plan went into operation? The same problem as always in an unregulated healthcare market – the young and healthy would flee to purchase cheaper insurance from low-regulation states, and there would be a race to the bottom. And the insurance companies would start flocking to these states too. This is an absolutely disastrous idea, where the true scale of disaster is hidden by ideological blinkers.

One more thing. For Catholics, coverage of abortion in health insurance plans is a huge issue – for many, the over-riding issue (let’s ignore the charlatans who hijack the unborn to serve the golden calf of the market). We know that the Affordable Care Act does not allow taxpayer funding of abortion, and any potential loopholes are covered by an executive order. The real issue is whether the Hyde amendment should be codified into permanent law, or left as an annual rider, as it has been since the 1970s. At least, people are finally realizing that this is the real issue, as the smoke from the incendiary devices thrown about by the National Right to Life Committee and their allies begins to clear.

But when compared to the impact of the Republican plans on abortion funding, this suddenly seems like the most marginal issue in the world. Tax credits? A massive government subsidy for the purchase of private plans that include abortion – since there is no appropriation, there is no way to restrict this subsidy right now. Second, think about the plan to allow competition across state lines. One of the strong points in the Affordable Care Act is the ability of the states to ban any plans offering abortion from accessing the exchanges. This applies to all plans, not just those accepting federal subsidies, and so – by regulating private insurance directly – goes well beyond the Hyde amendment restrictions. This would be gutted by Republican plans, as this could easily be circumvented by going to another state. I wonder why our Catholic friends on the right don’t mention these points, don’t you?

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  • Robert Klingle

    Right to life and the Catholic Right are not about abortion. They are about getting Republicans elected.

  • Your arguments would be more persuasive if you didn’t begin with your conclusions. You routinely beg the question, and you have done so once again in this post.

    • The Anglo-Saxon form of argumentation is based on putting one’s conclusions up front, and developing them. The French way is more linear, with each piece of argument building on the last, leading up to the conclusion. I’m indifferent as to which is better, but I was trained in the former.

      Anyway, do you have a substantive point about this post or not?

  • Ronald King

    It is more important for them to look right rather than left because their identity is on the right and they have demonized the left so it would be impossible for them to change their perceptions because it would create a cognitive disonance that would result in an identity crisis. They must stay within what they know because they are too afraid of the unknown.

  • Brad

    So is this piece about the Republican suggestion to replace the Obama plan or a diatribe against “Catholics on the right”?

  • sean

    The Republican plan is simple. Simply stay healthy.

  • Thales

    I don’t know where I stand on what is the best health care program situation.

    But any thoughts on HR-3, the prohibiting tax-payer funded abortions law?

  • Kurt

    HR 3?

    I think Vox Nova should get credit for its introduction.

    The bill bans many forms of alleged taxpayer financing of abortion that the RTL organizations had never before deemed to be abortion funding until either they found them in the health care reform bill or commentators on Vox-Nova pointed out their inconsistency in their acceptance of them in previous legislation.

    Clearly, they were listening to the accusations of hypocrisy.

  • MM writes, “It is really an ideological position, based on the cult of individualism, the liberal sense of responsibility for one’s own destiny.”

    I think you’re misreading your opponents’ position. Before the advent of Medicare and similar state programs, and employer-provided health insurance, there were plenty of charitable hospitals. Conservatives don’t oppose the idea of charity, of individuals banding together, or churches or charities being founded and contributed to for the purpose of providing healthcare for the indigent. The sole objection is to having government be the primary player.

    • Ronald King

      What are we to do if we are not charitable enough to provide for the poor?

      • Ronald writes, “What are we to do if we are not charitable enough to provide for the poor?”

        Well, what are we to do if we are not willing to be compelled by the government to buy health insurance? This is a democracy, we are supposed to decide policy based on the will of the people. If the people don’t will to do something, that is supposed to be the end of the matter. If you don’t like things that way, maybe you don’t like democracy. (Which is a position I don’t necessarily quarrel with.)

        The other answer, of course, is that if we refuse to exercise charity than we will pay the price in eternity. Since most conservatives are Christians (and most American Christians are conservatives), that would seem to be a strong incentive.

        • The idea that the right to universal healthcare – a right taught by the Church – can be attained by private charity is simply not a serious argument.

          And I’m tired of saying this, but here goes again – the American right is NOT conservative. It has adopted a rather virulent form of liberalism that embraces the supremacy of individual liberty over everything else. They try their best to squeeze Christianity into this box, and the result is not pleasant.

          • agellius

            The old brush-off … : )

          • Kurt

            Its not a brush off. It is simply a false statement to say before Medicare and union negotiated health insurance plans there were sufficient charity hospitals to meet the need. It doesn’t even come close to being true.

            The private market and private charity have failed to meet the needs of the people of this country for needed health care.

          • sean

            “The result”..is not Christian.

        • Ronald King

          Fear of God doesn’t seem to be a strong incentive. Why is it that the left seems more intent to develop universal healthcare than the right? Why is the left willing to give up so called freedom in order to care for the poor? Is the right afraid of losing freedom or are they afraid of losing something else?

          • Ronald writes, “Fear of God doesn’t seem to be a strong incentive. Why is it that the left seems more intent to develop universal healthcare than the right? Why is the left willing to give up so called freedom in order to care for the poor? Is the right afraid of losing freedom or are they afraid of losing something else?”

            Some would say that it’s because it’s part-and-parcel of leftist doctrine to believe that government can and should play the largest role in addressing societal problems. (Please bear in mind that I am playing devil’s advocate, as I noted in another post.)

            Some might also suggest that the left would rather have government deal with support of the poor in order to relieve themselves of the obligation to do it privately, since it is apparently the case that conservatives tend to give more to charitable causes than liberals: http://www.realclearpolitics.com/articles/2008/03/conservatives_more_liberal_giv.html
            http://taxprof.typepad.com/taxprof_blog/2005/11/generosity_inde.html

            I think it is the position of the right that our country was founded on the idea of government of the people by the people — not government of the people by the government. I think most conservatives would say that people certainly should pool resources in order to solve problems, but they should do it of their own free will and in the way they choose, and not under government compulsion. Government compulsion is necessary in some areas, for example the court system and law enforcement. But as a matter of principle it should only be implemented when strictly necessary.

            I can understand you disagreeing with that position, but surely you can at least understand it?

          • Kurt

            Some would say that it’s because it’s part-and-parcel of leftist doctrine to believe that government can and should play the largest role in addressing societal problems.

            And the some who say so would be wrong. The ACA is a fine example of the American liberal committment to pluralism. It involves a variety of actors with the private market having the largest role, with subsidiary roles for the federal government, state goverment, private initiative, family, and non-governmental CBOs such as union, churches and private charities.

            This is much more balanced than the suggestion that the private market be the only actors.

            Some might also suggest that the left would rather have government deal with support of the poor in order to relieve themselves of the obligation to do it privately, since it is apparently the case that conservatives tend to give more to charitable causes than liberals

            I think we have been through this with Austin. “Giving to charity” and “relief of the poor” are not the same thing.

            I think it is the position of the right that our country was founded on the idea of government of the people by the people

            So does the Left. It was the Catholic Church, not the Left, that first proposed government mandated insurance. The Left was very opposed to such schemes by non-democratic governments. Only with the development of democracy did the Left warm to social insurance.

            . I think most conservatives would say that people certainly should pool resources in order to solve problems, but they should do it of their own free will and in the way they choose, and not under government compulsion.

            The Right has not been very accomodating to allowing the non-rich to pool their resources for their economic betterment and at times has been quite hostile to it.

            Of course, the ACA give individuals increased ability to design how they receive health care.

  • Kurt write, “Its not a brush off. It is simply a false statement to say before Medicare and union negotiated health insurance plans there were sufficient charity hospitals to meet the need. It doesn’t even come close to being true.”

    I deliberately did not make the claim that there were, since I’m not an expert on the subject. At the same time, I don’t think the idea can be dismissed with a huff and a wave of the hand but deserves an answer.

    Americans give huge amounts to various charities. I think if they were paying less in taxes to fund government healthcare, it is quite conceivable that they would give to support charitable hospitals (if not out of Christian charity then perhaps in exchange for tax deductions). When people believe the government is taking care of a particular problem, I think they tend to feel less inclined to try to address the problem privately.

    I take that attitude myself (rightly or wrongly) a lot of the time when confronted with panhandlers: I think to myself, if he is really disabled then he would be eligible for government benefits, and if he’s not then he should be working.

    Of course, even if the government were not in the welfare business, I would probably take the same attitude, except that I would feel more obligated to give to charities that help the homeless and disabled, since there would be no other place for them to go for help.

    You’re free to dismiss these ideas summarily, but that’s not going to be persuasive to those who think otherwise.

  • Kurt

    Agellius,

    I don’t summarily dismiss the idea that through private charity we could acheive universal health care. I’m just asking for some hard evidence. I would be happy to consider anything you can provide but so far have seen nothing but unsupported assertions.

    • Kurt:

      I don’t necessarily claim we could achieve universal healthcare. As I said, I’m playing devil’s advocate.

      That being said, I’m not sure “universal healthcare” is necessarily the goal. What I’m talking about is assisting people who can’t afford needed healthcare to obtain it through private charity rather than through government. I can’t prove that it would in fact be provided to every person who ever needs it. But neither is it proven, as far as I know, that it would not be. It has not been tried in the contemporary era.

      All I’m saying is, if you want to persuade people that it wouldn’t work, it’s going to take more than an assertion that “this is not a serious argument” (as someone else said). If you don’t care about persuading people, that’s fine.

      By the same token you might say that if I want to persuade people that it would work, then I have to provide more than just an assertion that it would. Fine. But I’m not providing an assertion. I was responding to Ronald’s question about what the Right “fears it would be giving up” under government-run healthcare, by giving him the philosophical objections to it, as far as I understand them.

      But supposing we did try it, and found that at a particular time in a particular place, there were people in need of healthcare who could not find any available to them. I think that in that case, churches and charities would put out a call for assistance, raise money, and build facilities, as they often do in addressing other problems. I would not expect that this situation would arise and no one would do anything about it.

      But what difference does it make since this is a fantasy. Medicare, Medicaid and employer-provided insurance are here to stay, unless replaced by government-run healthcare, much as we might like to dream that it could be otherwise.

  • Kurt

    That being said, I’m not sure “universal healthcare” is necessarily the goal.

    Well,it is my goal, my friend!

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