Backing the GOP into a health care corner

If Democrats are the Party of No when it comes to issues such as Homeland Security and Social Security, Republicans are the Party of No on the issue of health care.

No, really. Go to the GOP website and click on the Issues header. Health care is nowhere to be found. Under Legal Reform, it only talks about "curbing lawsuit abuse with needed medical liability reform." The 2004 Party Platform has a bunch of platitudes like "We want more people to own and control their health care." The 92-page document proclaims its support for Health Savings Accounts, which are an important part of health care, but don't matter a whit to those who have been laid off their job and have no health care. It states support for liability reform because "junk lawsuits add at least $60 billion to health care costs in America," but that's pretty small potatoes compared with the $1 trillion spent on health care by government at all levels in 2003 (not to mention the nearly half-a-trillion spent by employers).

It goes on:

We must attack the root causes of high health care costs by: aiding small businesses in offering health care to their employees; empowering the self-employed through access to affordable coverage; putting patients and doctors in charge of medical decisions; reducing junk lawsuits and limiting punitive damage awards that raise the cost of health care; and seizing the cost-saving and quality-enhancing potential of emerging health technologies.

Don't get me wrong. I think all are worth pursuing, and the idea of government-funded health insurance -- a la Canada -- makes me shudder. But the statement quoted above makes Republicans sound like they don't get it. Democrats have the floor on this issue, and -- as the minority party -- can blame Republicans for blocking any reform they propose.

Some of this, I suspect, is because of the media's love affair with "progressive" ideas and its unwillingness to give equal time to the conservative equivalent. But much of it is simply a lack of ideas from the GOP.

Ross Douthat and Reihan Salam wrote about this -- among other things -- in the Weekly Standard a couple of months ago, theorizing that the huge prescription drug plan has left Republicans gun-shy about health care reform. They call on the GOP to offer "market-friendly health care reform," along with simplifying the system.

They also suggest looking at the issue not "as a problem for the uninsured -- a matter of charity for those less fortunate," but as a problem for those already covered. The people who are most worried about health care, they suggest, are "people whose insurance plans will lapse if they lose or shift jobs, whose plans don't cover expensive crises, and who must pay extra, in the form of higher premiums, to cover the medical bills of the permanently uninsured."

This, to me, seems very short-sighted -- especially when they noted a little earlier in the story that 45 million Americans are uninsured at any given time, but over a one-year period, the number is around 60 million, and jumps to more than 80 million over a two-year period. That means that, yes, 35 million Americans fall into the category of "people whose insurance plans will lapse if they lose or shift jobs," but what about the other tens of millions?

They also dismiss the reformatory fear of Republicans by insisting that "the health care system has become so complex and inefficient that a real reform could be crafted that would eventually pay for itself." They claim the country could move to a "more rational, market-oriented health care system" without spending any extra government money.

I bring all this up because Oregon's former governor, John Kitzhaber, is ready to mess with the state's health-provider machinery once again, in an attempt to provoke the federal government to grapple with how it provides care mechanisms such as Medicare. Kitzhaber, who was a medical doctor and state senator before serving as governor from 1994 to 2002, created the Oregon Health Plan in an attempt to cover the state's most needy residents. Trouble was, it required federal waivers from mandated care requirements, which the feds were never keen on granting. Its attempts to cover some people meant others were left out, and the state's budget woes over the last few years meant tens of thousands of people were dropped from coverage. (There's a good chance I'm completely misrepresenting the OHP, so feel free to correct me.)

Kitzhaber's new idea would require similar waivers, in the hopes that the feds would simply give up and tell Oregon to shut up and go away.

One of the stupidest things, to me, is that Kitzhaber's new proposal -- which would either come in the form of a ballot measure or with his announcement that he's running for governor again -- would eliminate tax deductions for employer-sponsored benefits. That will mean fewer Oregonians receiving coverage from their employers, and will mean the government shoulders greater responsibility (and cost) for that coverage. Which, I guess, is what Kitzhaber wants, but should not be what the Republican Party would want to see the federal (or state) government pursue.

For the country's uninsured, their fear is that they -- or worse yet, their child -- will face a serious illness that will leave them penniless or in even worse health. You can accuse me of buying into the Democrats' talking points on this issue if you wish, but it seems to me that unless the GOP develops some concrete proposals for this issue and trumpets them long and hard, the party risks a backlash for ignoring those fears.