Health care reform

The GOP's Health Reform Anxiety


There are two things to note about the health care portion of the Republican party's 2012 platform. The first is how much it differs from the 2008 platform, which, as The Washington Post's Sarah Kliff has noted, devoted only about 200 words to the subject and proposed no major reforms. The new document is far more expansive, with subsections devoted to Medicare and Medicaid, and an acknowledgment in the budgeting section that Medicare "is the largest driver of future debt."

Overall, it's reasonably strong statement from a party that has traditionally been loath to discuss major health entitlement reforms. But it still leaves the party plenty of wiggle room. That brings us to the second point, which is how  awkward and opaque the party's position on health care remains. You can see a clear desire to appease the base by pursuing those reforms, but you can also see a deep-rooted anxiety about how those reforms will actually play with the public, and seniors in particular.

The foundations are reasonably strong: The platform notes that both Medicare and Medicaid are fiscally unsustainable and elaborates on the way both have come to dominate the health system and public budgets:

Medicare has grown from more than 20 million enrolled in 1970 to more than 47 million enrolled today, with a projected total of 80 million in 2030. Medicaid counted almost 30 million enrolleesin 1990, has about 54 million now, and under Obamacare would include an additional 11 million. Medicare spent more than $520 billion in 2010 and has close to $37 trillion in unfunded obligations,while total Medicaid spending will more than double by 2019. In many States, Medicaid's mandates and inflexible bureaucracy have become a budgetary black hole, growing faster than most other budget lines and devouring funding for many other essential governmental functions.

In response, the platform recommends converting Medicare into a premium support system and pursuing state-based block grants for Medicaid. Those aren't the best solutions, but relative to the current situation, those are both promising reforms — reasonable and plausible ways to start transforming the U.S. health care system. But as Kliff notes, it avoids touching the larger and more difficult issue, which is the way the health system has been distorted by the tax deduction for employer sponsored insurance. That's not entirely surprising given the slew of political attacks suffered by Sen. John McCain, the last Republican presidential nominee to broach topic. But it still suggests a lingering reticence to even mention one of the biggest flaws in the country's health policy infrastructure.

There's a similar anxiety at work in the platform's Medicare and Medicaid reforms. The GOP platform seems to see its preferred entitlement changes as an end, not a beginning, framing these reforms as ways to preserve and protect both programs. It's a limited approach that assumes the centrality of these entitlements rather than questioning them, one that acknowledges that way both Medicare and Medicaid have overtaken so much government spending and activity, but promises to further entrench embed both programs into the firmament of American public policy. 


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  1. Yes, yes… but what color tie was Romney wearing today?

  2. a flood of posts about the convention *yawn* – wake me up when it’s over.

    1. Conventibate.

  3. Die Quickly! Why isn’t this a position that any politicians are actually running on? They could bring up stories of how some rotting old fuck cost his family millions of dollars because he had to be kept alive under any circumstance.

    1. You know somewhere around here I heard the words “Man up and die, people. Man up and die.”

      1. He deserves to spend $3 million of taxpayer money to keep him alive another week!

      2. Death Panels!!!!!!!!

          1. A cylindrical death panel? Is that anything like a circular firing squad?

    2. Die Quickly!

      You first Sparky.

      1. When my time comes I’m sure I’ll be happy to. In fact, I’ve already told my wife and children that I don’t want to be kept alive by a machine.

  4. Who did Suderman vote for in the last presidential election?

    1. He was not here so he did not do the reason “tell us who you voted for” thing.

      If I had to guess i would say he voted for Obama.

      I am also plenty sure he is not voting for Obama this year. Reading his articles for the past 3 years he has gone on a long and interesting journey of political discovery.

      1. Reading his articles for the past 3 years he has gone on a long and interesting journey of political discovery alt-text.

  5. On a general note the republican convention has made the news cycle suck.

    TEAM RED masturbation is more horrible to watch then 2 girls one cup.

    1. What are you talking about, Josh? I had a great time watching that.

  6. OT/ threadjack: Even Jalopnik is getting annoyed with hipsters. Is there anyone they haven’t managed to annoy and/or piss off?

    FTA: “The whole drive was intended to “spark our senses,” but it also gave me a window into how narrow GM is marketing the Spark. It’s a car made specifically for an age group that doesn’t give one shit about cars and would rather ride a bike.” And people wonder why GM is failing.

    1. That is the gayest looking car I have ever seen.

  7. kinnath’s health care plan is to encourage all people (especially children) to drink heavily, smoke copious amounts of tobacco, and engage in lots of high-risk hobbies like rock climbing (preferrably all at the same time).

    1. Rock climbing isn’t dangerous enough. How about unprotected sex rock climbing orgies?

      1. How about unprotected sex rock climbing S+M bondage orgies?

        1. I assumed that would happen naturally with all the harnesses and ropes.

    2. Unfortunately a teen or twenty-something who is maimed while doing something like riding an ATV can consume huge amounts of medical care before finally succumbing to something related to it twenty some years later.

      1. I should have said “overturning an ATV” not riding one.

  8. The first thing that needs to be done is to separate employment from health insurance. You can change the tax code to make any insurance you buy to not count toward your income. Not sure how this would work with FICA.

  9. “it avoids touching the larger and more difficult issue, which is the way the health system has been distorted by the tax deduction for employer sponsored insurance”

    How much does this matter post-2014 when, not only will employer sponsored insurance be encourage via the tax exclusion, but it will be required as enforced by employer penalties?

    1. But I learned it from you……..

  10. These technocrats will never stop fucking things up.

  11. The whole “tying insurance to your job” is one Libertarian obsession I don’t get. So what that your insurance is tied to your job? That doesn’t necessarily warp prices. Your employer is paying for that insurance and has every reason to keep insurance premiums down and insurance value up. Having a good health insurance plan is essential to hiring good employees in many fields. And health care insurance costs are a big expense. So employers have every reason to maximize benefits and control cost. So I am not seeing any perversion of the market there.

    The existence of insurance may cause people to over use it because it comes in set blocks. Once you pay the fixed cost and get the insurance, there is little marginal cost of using it. But that issue has nothing to do with getting insurance from your employer. People are risk averse and will always desire insurance.

    So what is the problem with the tax break? How is this anything but a meme that Reason trots out without really thinking about it or understanding it?

    1. Not every company can afford to provide health insurance. The tax break does warp the market as some people get the tax break if their company offers health insurance. If your company doesn’t provide health insurance you need to buy it yourself without the tax break. It will also make the average voter more sensitive to the price increases that are caused when politicians add new mandatory items in the insurance coverage. Insurance policies (used to) also refuse people with pre-existing conditions. If you lose your job you can’t get a new policy that was being covered under an old policy at your prior job. Bottom line it’s a 70+ year old reglatory ruling that is warping the market.

      1. add in

        *new policy for a pre-existing condition that was being covered*

      2. And the only evidence for that you give is that it makes the average voter more sensitive to certain price increases. Being more sensitive to price increases does not warp the market. It just makes demand more elastic.

        Try again because I am still not seeing it.

        1. Didn’t forget about you, that work thing you know. I guess I just don’t see how having a large tax break for some and not for others especially when that tax break leads to what amounts to a third party billing system has no effect. Also portability is a nice service to have which can’t be had at any price.
          Since the government has intervened in the market we’ll never really know if indvidual policies or group policies through companies is the right use of resources.

  12. OK, I don’t hate to complain.
    Whoever imposed the “Die Quicjky” message over the chart should learn haw to adjust the perspective to match the paper. That just looks bad.

  13. There are a lot of simple reforms that can help. Removing the interstate restrictions is one. McCarran?Ferguson should be repealed.

    The real importance of eliminating employer provided healt insurance is that Average Joe does not pay attention because he has little choice in the selection of the plan. He doesn’t see it as his money.

    I would invert the tax break. I would remove the employer provided tax break and allow premiums to be paid from HSA accounts by individuals.

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