Bobby Jindal

Can Bobby Jindal's Health Plan Get the Republican Party on Track?

The Louisiana governor's proposal could be a turning point for the party.

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Gage Skidmore / photo on flickr

Before conservative policy wonks can win any policy victories, they'll need to overhaul the Republican Party. For an idea of what that might look like and the challenges any transformation will entail, they should look to one of the party's wonkiest politicians, Louisiana Republican Gov. Bobby Jindal. 

Last week, as President Obama touted the 7.1 million private plan sign-ups in Obamacare's first open enrollment period, Jindal gave the world a glimpse at what the outlines of a Republican alternative might look like. Not only would the plan repeal Obamacare; it would, among other things, overhaul the tax code to remove the tax advantage for employer-sponsored health plans, offer incentives to states to protect access for individuals with preexisting health conditions, block grant Medicaid, expand health savings accounts, and create a $100 billion innovation fund for states experimenting with policies to bring down the cost of health care.  

But just as important as the particulars was the simple fact that Jindal was offering something that many Obamacare proponents, including the president, had said did not exist: a conservative health care policy. At the same time, Jindal's plan was a challenge to his fellow Republicans to take health policy more seriously, to reckon with the tradeoffs it requires, and to begin the process of unifying around an alternative. It was a declaration, of sorts, that Republicans and the right could—and should—be wonky and policy focused too.

Jindal's proposal, released by his policy group, America Next, was not the first health policy plan to come from the right. In recent months, Rep Tom Price (R-Ga.), as well as GOP Sens. Tom Coburn (Okla.), Richard Burr (N.C.), and Orrin Hatch (Utah), have put forth ideas for overhauling the health system as well. But Jindal's proposal is a sign that the party is shifting its focus—not by giving up on repeal of Obamacare, but by thinking about what might come next. And because Jindal is a potential candidate for the party's 2016 presidential nomination, it is also a signal that that health care reforms will be a major issue in elections to come.

Republicans have often struggled with how to talk about health care, especially when their opponents promise expansive subsidized coverage benefits. Jindal's plan offers a hint as to how Republican candidates might sell their approach: Instead of emphasizing coverage, Jindal's plan prioritizes reducing the cost of health care. That's a potential weak point in Obamacare, which was sold as a way to reduce health insurance premiums for families, but will, as President Obama admitted last week, still result in premiums continuing to rise. (Obama's promise is now that premiums will rise slower than they would have in the absence of Obamacare.)

At 26 pages, Jindal's proposal suggests mechanisms, but still lacks a number of specifics. It would limit the tax deduction for many employer-sponsored health plans, but doesn't specify which ones, or how much revenue would be raised in the process.

That's not ideal, but also to some extent necessary. Those details are left out partially because of political considerations: The more specifics a plan has, the easier it is to attack. But it's also the case that it's easier to build upon—and agree to—a general framework than it is to simply adopt a proposal with every tiny detail already decided. This is the start of the exploration and negotiation phase for GOP health policy. Part of the purpose of Jindal's plan is to prod others into thinking about the details themselves.

That's not something that Republican politicians have done much of recently. During the last two presidential administrations, the GOP has let its well of domestic policy expertise run dry. Under Bush, foreign policy concerns took precedence; under Obama, mantaining opposition to the president's agenda became the focus. At this point, Republicans are more comfortable talking about what specific policies they stand against than those they stand for.

Jindal clearly wants to shift gears by pushing the party in a more solution-oriented direction. His health care plan is intended as the first in a salvo of big-picture policy proposals set for release. Those plans are meant both to prod the party in a new direction and to establish Jindal as the leader of its brain trust.

His challenge will be to convert his policy chops into political success. Jindal has plenty of wonky cred, but his role in the party sometimes feels more like that of a particularly prominent think tank scholar than a national political leader. He's a Rhodes Scholar with an Ivy League pedigree, holding degrees in both biology and public policy from Brown, as well as a political science degree from Oxford.

Yet Jindal's record as governor makes it clear that he is more than an Ivory Tower geek. He has a real record of accomplishments as governor—cutting Louisiana's income tax, expanding access to charter schools, pushing budget reform, and growing the state's economy at a faster rate than the nation as a whole in the years since before the recession. His larger vision, meanwhile, goes well beyond small-scale policy tweaks.

Conservative wonks hoping to overhaul the GOP, or Washington, will have a significantly tougher time than any governor. The existing policy barriers—the mass of federal programs and bureaucracies, all with constituencies in tow—are larger, and the political incentives for even sympathetic politicians to avoid difficult reforms are bigger still. Jindal's health plan is a strong nudge to a party that has long lacked policy direction, and a reminder that there's no better time to start the process of change than right now.

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48 responses to “Can Bobby Jindal's Health Plan Get the Republican Party on Track?

  1. Anyone who thinks Congress making health benefits taxable will be accompanied by any off setting tax reductions and won’t be anything but just another excuse to fuck people up the ass is a liar or a moron. Whatever the merits of making health insurance taxable, no one should ever support it because in practice it will just mean a massive tax hike.

    1. Maybe they should cut back on those church deductions – that would seem reasonable, especially with some of these pastors and rabbis living in multi-million dollar homes and other palaces full of gold (I’ve been inside them…hard to imagine the riches of these churches).

      What possible reason could there be for us fighting over these little scraps like whether insurance is taxable when we are paying the bill for all those palaces, including the cults (scientologists, etc.)

      1. Pastors, rabbis, etc pay income taxes like anybody else. They are employees of non-profit companies, like millions of other tax payers are.

    2. Maybe they should cut back on those church deductions – that would seem reasonable, especially with some of these pastors and rabbis living in multi-million dollar homes and other palaces full of gold (I’ve been inside them…hard to imagine the riches of these churches).

      What possible reason could there be for us fighting over these little scraps like whether insurance is taxable when we are paying the bill for all those palaces, including the cults (scientologists, etc.)

    3. It may mean a massive tax hike, but in the long run reform is necessary because straightforward cuts will never fly. This is a worthwhile price to get the reform ball rolling.

      1. “Whatever the merits of making health insurance taxable, no one should ever support it because in practice it will just mean a massive tax hike.”

        TANSTAAFL!

        Currently we pay a Lot more for the “tax deductable” health care in market distortions than we would pay if it were just taxed as compensation.

  2. pushing the party in a more solution-oriented direction.

    Solutions being “more free shit” right?

    1. Not necessarily more, but different free shit, and with each change an overall reduction.

  3. Mr. Megan McArdle’s endless fascination with “wonks” (which he obviously thinks of himself as being) and the notion that the right set of said wonks can solve all of the world’s problems continues to be one of the most tedious aspects of the journal.

    1. Meh, Jindal tried to be an everyman and got laughed off the stage. He probably is of much better use as a wonk. I’d rather see him talk healthcare on the air than a blow-dried Ken doll like Reince Priebus.

    2. I’m looking forward to the inevitable TV sitcom about “Republican Policy Wonks”, with Deepra G. Savalia, “The Punjabi Michael J Fox”, as the roman ? clef version of Bobby Jindal.

  4. Double, or even triple, the number of medical schools. Let doctors compete with price and care level. The schools will be competing for students by that time and the doctors should as well, just like the rest of us when we sell our labor.

    Tort reform to lower medical malpractice insurance costs. ( We did that in Texas and the world hasn’t crashed and we actually experienced an increase in applications for Doctors to come here and practice.)

    Do away with any legislation that prohibits insurance companies from selling whatever insurance products they wish to offer.

    A mechanism for transparency in provider costs. It’s almost impossible to get price quotes from providers in advance. It can be successfully done in spite of many providers arguments against. Here is an example.

    http://www.surgerycenterok.com/

    Allow PAs to screen patients that see the Doctor so that he doesn’t have to take up his time with sore throats. Leave the Doctor liable for his PAs to ensure proper oversight.

    What’s wrong with government run clinics to replace medicaid and possibly Medicare? Farm out the serious cases with price controls and clinical supervision. It shouldn’t be expected to be cutting edge healthcare but hey, “it’s free” to the user.

    1. Don’t forget interstate sales…

    2. McMedical Schools, eh?

      These are gonna pop up overnight.

      What percentage of uninsured population y’all got there in TX? What $ did your medical costs go down from that tort reform (zero – they went up, as usual).

      Facts are stubborn things.
      “Moreover, the basic promises of the proponents of the medmal limits have never been met. They promised more access to health care, more doctors, and lower health care costs. But an objective study by respected academicians show no positive impact on the number of doctors. Even a leading critic of the plaintiffs’ bar declared that he would no longer claim that the Texas law increased doctor supply.”

      1. What percentage of uninsured population y’all got there in TX?

        You say that like it’s a bad thing.

      2. “McMedical Schools, eh?”

        What an ass.

      3. What percentage of uninsured population would you have there in Massachusetts, if it weren’t for your state law that forces people to be covered?

      4. What percentage of uninsured population would you have there in Massachusetts, if it weren’t for your state law that forces people to be covered?

    3. Nah, or at least nah to most of the above.

      How do you propose to multiply the med schools? It’s like you’re proposing to lower the price of milk by making more cows.

      What you should do instead is get rid of the state professional licensing laws.

      Most malpractice reform in some way or other deprives people of due process. Instead, adopt Richard Epstein’s approach and have judges treat malpractice via contract rather than tort law.

    4. Your thoughts on medical school are good ones. You are absolutely correct that we need more “supply,” and one of the reasons so many elect not to go to medical school is cost. Certainly there could be incentives to increase attendees as well as investment to build new ones.

  5. Every “plan” I see from government seems to attack the symptom of high insurance costs. The problem is healthcare costs. The cost of health insurance is a symptom of health care costs. To lower insurance costs you must first address care costs. Insurance costs reflect healthcare costs plus government intrusion.

    1. I liked the ideas in your initial post. I was surprised to see you mention competition among MDs but not among medical facilities.

      There are a significant number of men and women I know who served in medical capacities for the US armed forces and could aid in staffing a surge of new outpatient clinics, specialized facilities, and hospitals. I would invest capital in these types of operations if they were engaged in an entrepreneurial fashion by these individuals.

      I think the concept “Certificate of Need” needs to be attacked so that some of the policy changes you suggested become feasible.

    2. Not totally true. What’s to stop an insurance company from charging you 2X what their cost is?

      Nothing. Until the ACA.
      Now, they have to spend 85% of the premiums on health care. Sure, that’s one piece of the puzzle.

      Insurance, done right (regulated) is something we all use for big events like house fires, car crashes, death, etc. – nothing wrong with having safety in numbers.

      Countries like Germany and Switzerland with advanced universal health care still use insurance companies – but they are regulated as to profit (like ACA)…

      So, yes, health costs are also a lot of the problem but it’s easier to bring them down when more people are insured and proper science and medicine guides decisions…..instead of allowing free reign for the “free market” (predatory health care).

      Actually, whether you call it gubment, insurance companies, pools, buying groups, etc. – that all bring DOWN the cost of health care (or just about anything) because it’s easier to rip people off one by one than it is in bulk. This is why individual health insurance is 1/2 the price through the ACA….we (individuals) now get the same price as only big companies used to get.

      1. What’s to stop an insurance company from charging you 2X what their cost is

        Competition.

        Pretty much everything you say is wrong, but it’s worth addressing this point in particular:

        Actually, whether you call it gubment, insurance companies, pools, buying groups, etc. – that all bring DOWN the cost of health care (or just about anything) because it’s easier to rip people off one by one than it is in bulk.

        An anecdote: I was talking with an architect who works in Montreal (different country, but same principle applies). He was saying that the big architecture firms love to get contracts from the city or the universities. They automatically budget in an inflated cost. I forget the percentage he gave, but I think it was something like 5%. Part of the reason they do it is to account for extra time spent on navigating the bureaucracy, but it is mostly because they know they can. Government spends other people’s money. They don’t think they can run out, because they can either tax, borrow, or at the national level, print more. So the incentives for cost control simply are not as strong as when a cost overrun can put you out of business, or ruin your credit score.

        To repeat, you are wrong.

      2. What’s to stop an insurance company from charging you 2X what their cost is?

        Nothing. Until the ACA.

        Wrong. Insurance companies charge based on percentages and what they can negotiate with the hospitals who set the prices.

        This is what people like you don’t get. Federal expenditures on healthcare are over $1 trillion a year, and have been for some time. Obamacare didn’t do diddly squat to lower those costs.

        So, yes, health costs are also a lot of the problem but it’s easier to bring them down when more people are insured and proper science and medicine guides decisions…..instead of allowing free reign for the “free market” (predatory health care).

        Horseshit. We’ve had exponentially increasing numbers of insured on both public and private healthcare plans for decades. All it’s done is exponentially increase the cost of medical care.

        A normal, live birth and two days in a private room in the late 1950s-early 1960s was about $1,000, inflation-adjusted–the current average is now about $10K. This isn’t the result of some “free market” system, regardless of what you progs might imagine. It’s the result of pushing a philosophy that no one should be fully responsible for themselves at any time, for any reason.

        Going back to a cash-dominant payment system would cut medical costs by 50-80%–but you’d never go for it because in the fevered minds of progs, if someone else isn’t footing the bill for their needs, then you’re somehow being oppressed.

        1. “A normal, live birth and two days in a private room in the late 1950s-early 1960s was about $1,000, inflation-adjusted–the current average is now about $10K. This isn’t the result of some “free market” system, regardless of what you progs might imagine.”

          Well, now you are on a subject I happen to know a lot about. What was the percentage of vaginal births in those days? Wow – most of them……maybe 90%. What is the percentage these days? 30%

          I can’t school you on why…..but it’s a combination of things – many of them having to do with the so-called “free market”. Births are expensive (this is very roughly stated) because:

          1. Docs want to set appointments for births. This way, they can get in their golf games, vacations, etc. and not be bothered with days-long labor and overnight births.

          2. LOTS MORE MONEY – the free market at work. Why sell something for 1K when you can get 10K….

          3. Competition – Docs have shut down the midwifery movement in every way possible -so they can reap their 10K+. Nothing the AMA would dislike more than allowing births to go on like most every other country on earth does them.

          4. FEAR – that’s how we sell wars, large gun collections, gated communities and mass consumerism in this country. Fear is instilled in the patients so that any tiny percentage of things going wrong makes them “choose” getting their babies cut out instead of popped out.

      3. Actually, whether you call it gubment, insurance companies, pools, buying groups, etc. – that all bring DOWN the cost of health care (or just about anything) because it’s easier to rip people off one by one than it is in bulk.

        It’s hilarious that you don’t even see the contradiction in this statement from the previous paragraph that “free market” healthcare was ripping people off.

        No, the COST has not come down, not even a little bit–it’s just disguised because someone else is covering the difference.

        1. Another point to make. If a free market, if costs do go up, it’s based on people’s preferences and, therefore, is not necessarily bad.

          If you have an apple and where you work, people would pay 50 cents for it, but if you take that apple to where i work, people would pay $1 for that apple. The price went up, but that’s because, where i work, people really prefer apples compared to whatever else they would use that money for.

          This is different than a government using force in a market which results in higher prices.

      4. “Insurance, done right (regulated) is something we all use for big events like house fires, car crashes, death, etc. – nothing wrong with having safety in numbers.”

        If your assertion is correct, I can reasonably assume that you think medical insurance is currently done wrong.

        Medical insurance does not strictly pay for big events and Obamacare’s expansion of what “insurance” is required to pay for, has widened the gulf between it and your examples. According to the proponents of Obamacare, medical insurance that would parallel the type of insurance you have on your home, auto and life are substandard.

        1. Not true.

          I (and the ACA) have deductibles and things like that.

          I think what you meant to say is the super-weak GOP “insurance plans” (they are not allowed to actually call them insurance) are of that variety. You know – like if you lose 2 teeth, one eye and one leg in an accident, they will pay you 5K…..

          If you have a mortgage (and most do) or a car loan, you know very well that your insurance has to be faitly full.

          To make a comparison to your “free choice” initiative, I would say this. Yes, I think anyone who is willing to put up 2 million dollars in full escrow to pay 100% for their medical costs should be able to sign a waiver and not have to be insured. But since the total number of people willing to so that is probably way less than 1/2 of one percent, we can’t really make that public policy. That’s why we have insurance pools

        2. Not true.

          I (and the ACA) have deductibles and things like that.

          I think what you meant to say is the super-weak GOP “insurance plans” (they are not allowed to actually call them insurance) are of that variety. You know – like if you lose 2 teeth, one eye and one leg in an accident, they will pay you 5K…..

          If you have a mortgage (and most do) or a car loan, you know very well that your insurance has to be faitly full.

          To make a comparison to your “free choice” initiative, I would say this. Yes, I think anyone who is willing to put up 2 million dollars in full escrow to pay 100% for their medical costs should be able to sign a waiver and not have to be insured. But since the total number of people willing to so that is probably way less than 1/2 of one percent, we can’t really make that public policy. That’s why we have insurance pools

      5. What’s to stop an insurance company from charging you 2X what their cost is?

        You. You would stop them. Would you pay 2x as much for an insurance company to pay for your care as you could have just paid yourself? You would not, unless the risk of incurring that cost at once is worth you paying 2x as much over time to mitigate.

  6. Here’s another one: institute a National Medical License and eliminate State licenses. Right now it can take six months to a year, with tons of paperwork and thousands of dollars of cost, to get licensed in another state. Result is doctors rarely moving, there is almost no competition or even candidates for many positions, so it is very difficult to keep clinics and hospitals staffed, and doctors have a seller’s market for their services (which continually elevates reimbursement levels).

    Also, telemedicine could dramatically lower costs and help underserved areas get full access to specialty care — but once again, docs can’t practice across state lines. So the technology is years and years ahead of thre regulations, denying potentially life-saving, high-quality care for really no reason than states don’t want to give up their licensing monopolies.

    1. Why have any license?

    2. how about remove all licensing. Then, not only can doctor’s within the US move to where they are most needed, but doctors from all over the world can easily immigrate and begin practicing, greatly increasing the supply of doctors.

      Doctor’s credentials should work like certification anywhere else. For example, you don’t need to be certified in Lean to be the Lean Manager where you work, but having that certification can certainly help you get higher pay. It’s not a barrier to entry, though.

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  8. My Bobby Jindal is hurting again.

  9. can i win bobby jindel’s innovation fund by proposing that we lower costs and increade health care access by getting rid of insurance companies? let me know where i can submit this idea to this whiz kid wonk.

    1. Get rid of insurance companies? How many are you willing to kill? A socialist advocating violence?? I never thought it could be!

      On a serious note, that is what socialism requires in order to survive, either the threat of or acts of violence.

      The only way costs of care will go down is through the voluntary actions of free individuals in a free market. Government collusion with corporations, along with regulations written in favor of special interests and the meddling of government in the market will lead to higher costs. The socialists rely on a market pricing mechanism for the “top men” to set prices. So socialism in itself can never economize, which will always result in inefficiency, and with socialism there is no pricing mechanism other then what the central planners dictate. But to hell with economic history, lets just keep pushing socialism over and over again expecting different results other than the failure that it is.

      And I’ll say it again, the only reason why this nonsense is still pushed is because folks are shielded from consequences. Go try and “get rid of” the insurance agents yourself. I doubt you’ll get far, especially if they are able to defend themselves.

      1. “If one rejects laissez faire on account of mans fallibility and moral weakness, one must for the same reason also reject every kind of government action.” Ludwig von Mises

        1. “Socialism never took root in America because the poor see themselves not as an exploited proletariat, but as temporarily embarrassed millionaires.”

          – John Steinbeck (disputed)

          1. I could agree with that to a point. Our poor (at one time, anyway) rightly see themselves as potentialy wealthy, and with enough hard work and ingenuity they could become whatever they wanted. They value their freedom and liberty, because those things are the tools of wealth creation. Other nation’s poor, used to a controlling monarchy or ruling class (TOP MEN), see their status as the product of other people’s designs. Rightfullt to a degree it’s no fault of their own, because they have no concept of liberty, and as such little concept of enterprise or wealth.

            So it’s like Stockholm Syndrome. Freedom is scary, and those people doubt that they are smart, or enterprising enough to become wealthy, so they become Socialists instead and make sure that no one can succeed. So all of the enterprising, smart, fit people, the cream of the social crop, left safety behind and came to America to hack a living out ot the woods and fields. All of the Europeans craving safety and security, and a firm guiding hand of a government to tell them exactly what they could and would be, stayed in Europe. So another way of saying it, is that Socialism never took root in America because most Americans are not cowards.

  10. Here’s a link to an article about Coburn’s plan.

    http://www.forbes.com/sites/th…..obamacare/

  11. Guess which of these cabinet posts belongs to Jindal?
    The military has a rule-of-thumb to assure clear and timely communication up and down the chain of command. In general, they have no more than six or eight persons reporting to a single superior. Contrast that with the cabinet of the executive department:
    1. State
    2. Defense
    3. Justice
    4. Treasury
    5. Agriculture
    6. Commerce
    7. Labor
    8. Health and Human Services
    9. Education
    10. Energy
    11. Homeland Security
    12. Transportation
    13. Interior
    14. Housing and Urban Development
    15. Veteran’s Affairs

    And “cabinet level positions”

    16. Chief of Staff
    17. Environmental Protection Agency
    18. Management and Budget
    19. Trade Representative
    20. Ambassador to the United Nations
    21. Council of Economic Advisors
    22. Small Business Administration
    Let’s start over, letting the redundancies and overlaps be resolved by crowding them together.
    1. State
    2. Defense
    3. Justice
    4. Treasury
    5. Natural Resources
    6. Human Resources

    1. I think the real problem is the idea that you can delegate responsibility. This is really just throwing people under the bus. As an example, Obama should be going to jail alongside Lois Lerner for the IRS scandal. He appointed her to run the IRS. The authority to oversee the operation of the IRS was delegated to her and she used it as a hammer to smash his opponents. He is responsible as much as she.

      1. This is probably the biggest bunch of BS I have read among heaps of it.

        Listen – certainly you know that the entire invention of the corporation and Limited Liability companies is specifically to protect both the assets and persons of the participants. How many people from Union Carbide went to jail for killing thousands in Bhopal? How many corporate executives on Wall Street have seen the inside of a prison.

        Government officials are also largely exempt from prosecution. If they were not, we’d never fill the jobs..simple as that. You can kick them out, impeach them…and in rare cases like Nixon, maybe even get them in jail. But, as you see, Nixon was pardoned (by Ford).

        Let’s talk about reality rather than pipe dreams. It’s not named “pipe dream rebellion magazine”. It’s named Reason.

  12. “offer incentives to states to protect access for individuals with preexisting health conditions … and create a $100 billion innovation fund for states”

    Jindal shows he’s a Republican interested in spending a lot of money. I’m waiting for a plan that removes government from the health care industry, similar to how government doesn’t regulate the computer industry.

  13. This is a worthwhile price to get the reform ball rolling.

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