Senators Burr, Coburn, and Hatch have put together a healthcare reform proposal that they call the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act. Maybe we shouldn’t bother to take this seriously since Republicans have only ever supported healthcare reforms that are in no danger of being enacted. But let’s play along in a spirit of bipartisanship.
First off, these three Republican Senators have an immensely popular idea that I’m sure will help this law sail through Congress:
About 85 percent of Americans get health benefits through their job. Those health care benefits have two kinds of tax protections. First, the employer can deduct its costs. Second, the employees’ share of their premiums comes out of their paychecks before taxes are taken out. The GOP plan would cap that exclusion, so that only 65 percent of the average plan’s costs would be tax-exempt.
The PPACA (or “Obamacare”) has what some call a three-legged stool: it aims to get coverage for those with pre-existing conditions. Once you do that, though, people might only elect to buy health insurance on the way to the hospital, and, at that point, it ceases to be insurance, it is no longer socialized risk. So you have to get everyone to sign up. You need a mandate. Once you try to put in a mandate, you see that some people will need premium support to be able to afford insurance.
Well, what does the chimerical Patient CARE Act propose?
Obamacare requires insurers to cover people with preexisting conditions. The GOP plan would extend that requirement only to people who have had continuous coverage. So, if you lost your job and immediately bought insurance on your own, you’d be protected. If you let your coverage lapse, you’d have to pay more because of your preexisting condition.
So if I get this right, the Republican proposal guarantees coverage for preexisting conditions for those with preexisting wealth.
My favorite aspect is this wonderful chart the Senators have provided. (I like how they claim that their plan will reduce premiums and the PPACA won’t. I admire people who make things up boldly. It’s a skill I lack. In fact, there’s some evidence that the PPACA has brought down the price of insurance — if only by creating a more transparent market.) My favorite, though, is how they regard it as an improvement that they will eliminate funding for federal comparative effectiveness research. The only rationality in which Republicans apparently believe is that of the market, and so it is laudably consistent for them to favor quackery and speculative medicine.
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