“I think that good policy is also good politics for Republicans. Even if they take the most cynical view of the Blair House meeting, I recommend they take the invitation at face value and attempt to participate constructively.• Show up as invited.
• Focus your public comments on substance more than process. Republican leaders are spending too much time on a “start over” message. I would instead talk about why you oppose the House-passed and Senate-passed bills, and how you are open to any legislative process and solution that addresses those problems. Since the policy problems are core to the bill, you achieve the same effect, but you will be getting your substantive message out rather than looking like you’re bickering over process.◦ The bills create a nearly trillion dollar entitlement program when we know that entitlement spending drives our long-term budget problem.
◦ The bills slow the growth of Medicare spending (a good thing) but then turn around and respend that money on a new spending program (bad).
◦ Health insurance would essentially become a governmental function, even without a public option.
◦ More decisions about the costs and benefits of various medical procedures and treatments would be pushed away from individuals and toward government officials.
◦ National health spending would increase. Health premiums would increase for most who have employer-based health insurance today. The cost control measures, weak as they were, have been further watered down to the point of irrelevance.
◦ The bills are filled with targeted benefits and carve-outs: especially the Nebraska and Louisiana Medicaid deals, exempting unions from the Cadillac tax, and carve-outs for certain Blue Cross / Blue Shield plans.
• Offer a wide range of substantive health policy changes (to current law, not to the bill), but do not feel obliged to have a single unified Republican proposal. It’s critical that Republicans step up and offer policy solutions, but they don’t have to be afraid of admitting that they are not unified as a party on those solutions.
Different Members can push for different reforms: talk about medical liability reform, buying insurance across state lines, replacing the current law tax exclusion with a deduction or a credit, high risk pools, association health plans, health savings accounts and high deductible health plans. Republicans need to be aggressive in pushing positive policy ideas for health policy reform, even if they disagree amongst themselves. Embrace the differing views within the big tent, and use those differences to make your argument for an open amendment process.”
Keith Hennessey, “The Blair House debate”, KeithHennessey.com (15 February 2010).
http://keithhennessey.com/2010/02/15/blair-house/
Keith Hennessey was Assistant to the President for Economic Policy and Director of the National Economic Council under President George W. Bush. It is the position now held by Lawrence Summers under President Barack Obama. His blog was recently named by the Wall Street Journal as one of its “Top 25 Economics Blogs”.
At a time when the economy is stagnate and the financial system remains in disarray, the Administration insists on continuing a fruitless debate about its version of health care reform even though it is clear nothing substantive will come of it. I suppose if I were a policy wonk like Hennessey, I would suggest to the Republicans something along the lines he has proposed above.
Fortunately (for the Republicans) I am not a policy wonk and have no interest in providing them with ideas for a health care debate with the President that I believe will go nowhere. So, instead, let me make some suggestions about what the Republicans should recommend in the area of health care. It can be summarized as follows: Scrape the President’s comprehensive approach to health care reform and instead make modest and steady changes over several Congresses along the following lines.
1. Move to a government-supported system that provides catastrophic health care insurance for all citizens that would cover very high cost, relatively long-term and narrowly-defined medical needs. Limit this coverage to medical conditions that are truly life-threatening or family-destroying.
2. Focus on strengthening private major medical health insurance and slowly and steadily discourage the use of the comprehensive health insurance packages the government has mandated to cover relatively minor medical expenses. Encourage people to pay for the normal and regular health expenses from their own pocket or through high deductable major medical plans.
3. Do not use government regulations and mandates on health insurance companies in an attempt to widen insurance coverage to the poor. This only results in cost-shifting and greater administrative expenses. Rather, any new subsidies intended to cover the poor should be in the form of health care vouchers which should be paid out of general revenues, not linked only to wages. Eliminate Medicaid by substituting health care vouchers.
4. Encourage charity care in the area of health care.
5. All savings garnered from efficiency gains in Medicare should be used to shore up Medicare. No savings in Medicare should be used to fund new health care insurance subsidies or an expansion of current entitlements. Raise the age of eligibility and deductibles to benefit from Medicare.
6. Step-by-step introduce the following kinds of health insurance reforms:a. Allow interstate competition in health insurance.
b. Remove the preferential tax treatment of employer-provided health insurance.
c. Remove restrictions on the portability of health care insurance.
d. Allow individuals to waive extraordinary litigation claims in return for lower premiums, perhaps capping them at $1,000,000.
e. Move to widen the kinds of procedures that nurses and other medical staff can undertake to weaken the doctor’s monopoly on the provision of skilled medical care.
7. Increase the supply of medical care providers by:a. Increasing the number of medical schools, nursing schools and technical schools providing training in medical specialties.
b. Allow medical professionals with licenses in one state to practice in another state.
Many of these reforms would not cost a dime and others would reduce the present cost of health care insurance significantly.
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