Finally, A Republican Plan

Yesterday, Global Review published a complaint that Republicans have squandered the opportunity to offer a clear alternative to the quasi-socialization of medicine. We complain, they respond.

Congressmen John Shadegg (R-AZ) and Pete Hoekstra (R-MI) have an excellent policy memo in the Journal today, laying out clear rationale and a smart plan for reform.

Thousands of foreigners come to America to get care each year; in 2008, some 400,000 people traveled here for treatment... The problem is that some in America cannot access this care. Republicans and Democrats agree that we should cover all Americans.

They highlight cost control, pre-existing conditions, and non-insured Americans as the key areas of reform. The most interesting feature was the GOP approach to the pre-existing condition problem:

In 2006, the Republican Congress and President Bush passed legislation encouraging states to create "high-risk" pools where those with pre-existing conditions could receive coverage at roughly the same rates as healthy Americans. State-based high-risk pools spread the cost of care for those with chronic diseases among all insurers in the market. The additional cost of their care is subsidized by the government.

Unfortunately, some states have not created high-risk pools, and some need to be restructured to ensure timely access to care.

This system has been insignificant so far because the market for health plans remains uncompetitive; the first part of Shadegg & Hoekstra's proposal would start to address that problem.

The congressmen also propose government vouchers spent by low-income consumers in the marketplace as a means of covering the uninsured. This certainly seems to me the most sensible idea (it's similar to how Medicaid works in some states), and it would give the poor access to the same health care as the rest of us.

This brief article doesn't go far enough in describing how means-testing would work for the new Medicaid, or whether penalties would be levied against people who want to slide by without health insurance.

Nor does their proposal for increasing competition by removing the self-insurance penalty seem like it will be enough to actually get competitively priced individual plans. I think that it's probably necessary to do away with employer-provision altogether, and put the onus on consumers to buy their own health insurance - just like they buy their own car insurance and home insurance.

The next step for Shadegg, Hoekstra and friends is to take the message beyond the friendly readership of the Wall Street Journal. The best way to move beyond the Town Hall anger of August and resolve the public debate over health care is for voters to see some alternatives and be able to choose among them through their elected representatives.

Posted by Chops at September 5, 2009 8:57 AM
Comment #287545


Thanks for this info. I hadn’t heard it before. It sounds like a reasonable approach. It may well be too little too late, however. Sadly, this seems to be a modus operandi of Republicans.

Posted by: gergle at September 5, 2009 12:03 PM
Comment #287546

Re: Pre-existing conditions. This should be totally abolished. There should be no need for any “high-risk” pool. Insurance companies should not be able to deny care or terminate policies for pre-existing conditions or reaching a maximum of “coverage”.

This idea presented above is too simplistic and still protects insurance companies.

It is good to see any Republicans at least addressing the issue, but they have a way to go.

Posted by: womanmarine at September 5, 2009 12:06 PM
Comment #287551
We complain, they respond.

Err - sorta. When I saw the headline of the article, I was hoping to see a substantial alternative, full of comprehensive ideas and an explanation of how it would be paid for. You know, a “plan.”

A one page op-ed throwing out a couple of ideas? That’s really not what we were looking for.

The recent cover article in The Atlantic covers a lot more ground.

Posted by: LawnBoy at September 5, 2009 12:58 PM
Comment #287556

Lawnboy, Womanmarine & gergle

It may not be much in details, but it is more coherent and details than the many confusing plans we are getting from the Democrats.

The reason health care reform has been so hard has been the lack of a good plan and/or actually bad ideas floated by Democrats.

You are right that it is a little late for some adult supervision for the incompetent congress, but that is not a Republican problem.

Posted by: Christine at September 5, 2009 2:28 PM
Comment #287567

Too little too late. You had eight years to do something but the republicans just wanted to wage war and cut taxs for the rich.

Posted by: Jeff at September 5, 2009 9:05 PM
Comment #287570


Nice excuse for a complete lack of vision from Republicans. With that kind of spinning, being airborn should be no problem at all.

Posted by: gergle at September 5, 2009 10:22 PM
Comment #287571


I’ll eventually read the article, but the first few paragraphs pissed me off, and pretty much relegated this article to the dust bin. “My father was killed by the healthcare system”, as though him being 83 with pneumonia had nothing to do with it. It’s exactly this kind of nuttiness that leads to want to squeeze bleeding heart morons to death. I guess I could blame the newspaper industry.

Posted by: gergle at September 5, 2009 10:27 PM
Comment #287572


The Democrats are making promises and proposals. Can you tell me what their plan says and how they intend to pay for it?

The problem for the Democrats is that a majority of the American people don’t trust them on this because even with our less than stellar education system most Americans can count well enough and understand that you cannot get something for nothing.

Posted by: Christine at September 5, 2009 10:27 PM
Comment #287573

BTW - I regret that we will not get health care improvements. We do indeed need it. But we will have to wait for a competent congress and a stronger president. The Pelosi team is not good enough and Obama is not experienced enough.

Posted by: Christine at September 5, 2009 10:30 PM
Comment #287574


A successful health care proposal must have at least these three things:

1. Tort reform
2. Some sort of rationing
3. Equalizing tax treatment on employee benefits, in order to move away from employer-based systems.

When the Democrats (Or anybody else) proposes these things, we will know that we are on a serious track. Until then, it is nothing but posturing and BS.

Posted by: Christine at September 5, 2009 10:35 PM
Comment #287582

“But we will have to wait for a competent congress and a stronger president.”

Good luck with that…at least, in our lifetime.

Posted by: jack at September 6, 2009 10:02 AM
Comment #287588


I wonder if it’s going to be tough for you when reform is passed, like when the majority of Americans elected that weak candidate Obama? I’m guessing fantasy is all Republican cheerleaders have to rely these days.

Posted by: gergle at September 6, 2009 11:06 AM
Comment #287589

Our ideas save more money than your ideas.

Earlier this decade, the Republican Party had it’s chance to reform. It instead, without blinking, added hundreds of billions of dollars in new medicare liabilities.

Part of this was useless subsidies given to the insurance companies for their administration of the Medicare Advantage plan. Another part was the Medicare Drug Benefit, which the Republicans allowed to be set up with no provision for the Government acting like any other actor in the market would: with bargaining power.

Part of how we pay for the new healthcare will be to cut back on some of these useless expenditures.

That’s the Irony: not only is the Democrat’s version of healthcare more fiscally sound, but it makes itself that way by rolling back some of the Republican’s own fiscal insanity.

Posted by: Stephen Daugherty at September 6, 2009 11:49 AM
Comment #287590

Reforms? More fiscally sound? When? I’ll believe it when I see it. Of late, deficits are at record levels, which isn’t fair to future generations. The claim that either are fiscally responsible is laughable.

Posted by: jack at September 6, 2009 11:59 AM
Comment #287592


Nobody but you thinks the reforms save any money. The non-partisan CBO says it will cost a lot more and in fact bend the cost curve UP.

I believe that we should have health care like they have in Scandinavia. It is cheaper, but it also features rationing, protections against law suites, and less total choice.

Democratic proposals are claiming they will essentially extend the programs that a well-insured American has to the whole population and make it cheaper. This is not possible. The American people can count. They know this. So do Democrats in congress. They were caught in their lies. They thought the American people were stupid.


Obama is a superb candidate. He plays the role perfectly. He just doesn’t have anything BUT the image. That is why he is such a disappointment. He seemed so great but he lacks the experience and maybe the character to run the country.

It is easier to promise than deliver and it can trick people into electing good looking but incompetent leaders. That is one of the weaknesses of our mass democracy.

President Obama has given dozens of speeches about health care w/o laying out a firm position. Maybe he will give us details on Wednesday. He will have to kick some of his lefty supporters.

If the speech makes Pelosi happy, it will not be what America needs. I hope Obama turns out to be the man we hoped he was. But I fear experience will obliterate hope.

There is room for a good program, one that cuts costs, includes tort reform and allows competition across state lines. Obama knows what it is. If he has the courage to articulate it, he will be a great president.

BTW - one reason our European and Canadians friends get such a good deal on drugs etc. is that we Americans pay a lot more for innovations. They are free riders. We ALL cannot get the good deal. Reform in the U.S. may lower our costs and raise theirs, but we all cannot get the good deal they do now.

Posted by: Christine at September 6, 2009 12:33 PM
Comment #287594

Hi Jack!!! We Miss you…

Posted by: papioscarw at September 6, 2009 1:53 PM
Comment #287599

It amounts to roughly thirty billion extra dollars a year in new deficit spending, to head off a much more ruinous increase in Medicare costs. I think it’s worth the price.

And we haven’t even gotten around to what it will save Americans and businesses, to get this healthcare in place. The Republicans boast about saving taxpayer dollars, and we end up with larger government and higher spending. Democrats actually go out there and balance the budget.


Nobody but you thinks the reforms save any money. The non-partisan CBO says it will cost a lot more and in fact bend the cost curve UP.

Site the report, and the bill. According to the CBO, the public option saves money for the government. The CBO figures are where we get the 269 billion dollars over ten years, which translates to 26.9 per annum.

Healthcare costs are skyrocketing. Ten years from now, we’ll be paying two trillion dollars more per year. Or, put another way, if we put together the budget costs of healthcare, less than a trillion dollars over ten years, It will cost twice that much a year to do nothing.

Quit talking about lies. Your side is awash in them. All your side has achieved is confusing people over the truth, not enlightening them. Yours is the side whose program is more costly. Pennywise, pound-foolish.

Posted by: Stephen Daugherty at September 6, 2009 3:15 PM
Comment #287600


Yep, avoiding the Bush Depression was completely“` ineffective. I’m guessing you also advocate keeping one’s children from being indoctrinated by this commie phony?

Posted by: gergle at September 6, 2009 4:05 PM
Comment #287605

“They thought the American people were stupid.”

The American people are stupid, and already overmedicated, and the POTUS does not understand how to deal with that, other than giving more speeches which cause the right wing to compare him to Castro. There needs to be some kind of overall plan where he can show that some government functions are being reduced rather than just more of everything. Otherwise, people are not going to be willing to pay even if they were able to, in an continuing economic decline.

What will ultimately happen is that in addition to already having to pay for other peoples’ health care, while declining it for myself, I am going to be forced to buy insurance costing the same as the state income tax here, because people who are actually healthy are considered to be getting a free ride in this upside down government plan. I would rather make insurance illegal. It’s based on gambling anyway, and the house always wins.

Posted by: ohrealy at September 6, 2009 5:16 PM
Comment #287608


Your analysis of the bill is at odds with the non-partisan CBO. This here is a citation - this link.


Bernake and Paulson did a good job. The second stimulus - the one associated with Obama - has not had time to have any effect. Most of it won’t even be deployed until after next year.


The American people are not stupid. They currently have some stupid choices made available by the Democrats in congress, who correctly identified the health care problem, but prescribed the wrong medicine to cure it.

We may have to wait for a competent congress and a stronger president to get real reform.

I still have a glimmer of hope that President Obama will be the man Americans thought he was and do the right thing. We will see on Wednesday. If Nancy Pelosi is still grinning, we will know he is not up to the task of disciplining the extremists.

Posted by: Christine at September 6, 2009 5:35 PM
Comment #287610

Insurance takes risk that an individual cannot afford, and spreads it across a group based upon statistics/actuarial tables. Having said that, the idea of health insurance makes no sense. It manufactures nothing, produces nothing, and provides no essential service that could not easily be replaced by government. I can think of few more expendable private industries than health insurance. Some countries provide universal health care through heavily regulated quasi-independent private insurers.

My retired relatives in Florida are up in arms. They used to be conservatives. They turned against the Republicans in 2004 because they are naturalized citizens, and they got the message from the GOP that Republicans are hateful bigots and really don’t like people who are dark skinned and speak spanish (although my relatives also speak several other languages). My relatives got the message of hate loud and clear. They used to like Rush Limbaugh, but one time they heard him make fun of the way a politican pronounced a name just because it was different from the American pronunciation. That was that. Limbaugh’s hatefulness and bigotry were undeniable. They were done with Rush.

Most of their friends in a retirement community think Obama wants to euthanize people over 65. The retirees really believe it.

That is the conservative plan: confuse, mislead, and frighten people; if possible, find a way amidst the confusion to give private health insurers and Big Pharma even more money. That is the conservative plan.

Posted by: phx8 at September 6, 2009 5:48 PM
Comment #287613

Bernake and Paulson did a good job.

Yes, of watching the economy drive over a cliff. I don’t deny that Paulson did the typical too little too late Republic dance, which is why a second stimulus was needed and has had the desired effect, though I do not think we are by any means out of the woods. Unraveling the fiasco of Bush will take some time.

Christine it really is time to take off those rose colored glasses. Wake up and smell the coffee. This is the same dog pony show of McCain. It didn’t work in 2008 and it ain’t working now.

Posted by: gergle at September 6, 2009 6:44 PM
Comment #287614


You said it. Some of these people are gullible. Your relatives believe Republicans are hateful bigots and others believe other lies. I hope you pointed out where your relatives were wrong.


You were the one talking about the stimulus stopping the recession. If it did, it has to be the Bernake-Paulson action. The Obama-congress one had not had time to be effective.

The Obama stimulus is very slow, only around 10% is deployed. But the rest is coming down the track like an overloaded freight train. The Obama stimulus will come on line just about in time the economy is moving into high gear and will cause stagflation. If you liked the late 1970s and early 1980s, you will love what is coming.

I happen to believe the the gravy train stimulus will harm the economy, but let me tell you the secret of politics, Obama will get blamed when this sh*t hits the fan around 2011.

SO you will have another reason to blame Bush. I believe the Obama economy will be screwing up all by itself, but the conspiracy guys will say it is Bush clawing back with his little timed release pill.

Posted by: Christine at September 6, 2009 7:46 PM
Comment #287615

Well, good luck convincing my relatives the GOP is not a party of hateful bigots. Rush Limbuagh is the titular head of the party, and it is not possible to take back his comments. Furthermore, the GOP does not denounce his repeated examples of hateful and bigoted commentary. In fact, elected Republican congressman apologize to him if they contradict what he considers true conservatism. The same is true of people in appointed positions, such as the head of the GOP, Steele.

The Southern Strategy, a strategy which intentionally exploited hatred and bigotry, was pursue by the GOP. The previous head of the Republican Party, Ken Mehlman, apologized.

It is what it is. Feel free to prove me wrong. Name one black Republican senator or representative.

I suppose you could name Colin Powell, who was appointed, not elected, but last I heard, Rush Limbaugh evicted him from the GOP.

Face it. The Republican Party has become almost unrecognizable. The hatred for Obama, powered by bigotry, has twisted the face of the party into an enraged, ugly mask- and behind the flying spittle and raving insanity about how Obama wants to euthanize people over 65, and set up “death panels” for Palin’s baby, and indoctinate children into his socialist policies with this week’s speech, and how he is not eligible to be president because he is not a US citizen, behind all this craziness there is a simple motivation beneath the mask.

It is what it is. The next question is, who wants to be associated with this party?

Posted by: phx8 at September 6, 2009 8:23 PM
Comment #287618

And the Democrats aren’t hateful? During the Bush years all the hate that spued from the Blue side. Like some others say “what goes around comes around”

Posted by: KAP at September 6, 2009 9:06 PM
Comment #287619


As you said, your relatives believe a lot of things. I figure I won’t be able to get them to drop their prejudice and you will have a similar problem disabusing them of the death panel BS. We are both out of luck fighting ignorance.

You know what the word “titular” means. Rush is precisely NOT the titular head. I think the phrase you may be searching for is de-facto. That also is not true, but that is what you think.

It is possible not to agree with Obama and not be a racist. In fact, it borders on racism to think otherwise, doesn’t it?

Blacks tend not to vote Republican. That is important electorally, but indicates nothing as much as historical allegiance going back to the New Deal. I won’t say that it is based on racism. People can vote as they think right.

There is significant racism, of course. But now that Van Jones has resigned I don’t find that much in the Obama camp.

Republicans appointed the first black Supreme Court Justice, the first black SecState and the first black woman SecState. This is the job held by Thomas Jefferson, BTW. That doesn’t seem particularly racist. If so, I wish I could be a victim of it.

Posted by: Christine at September 6, 2009 9:08 PM
Comment #287626

Actually, I used the word “titular” correctly. Limbaugh is head of the party in name only, without the actual duties or functions associated with the position.

It is absolutely possible to disagree with Obama without being racist. The disagreement may involve policy, or simply a dislike of his character. However, the wildly irrational charges that are thrown at Obama again and again on a variety of issues suggest the hatred is more deep seated. Worse, the leaders of the GOP and the Republican Party remain silent.

I didn’t follow the story about Van Jones. He was a minor functionary who was a “truther.” I don’t think truthers are motivated by racism, but like any conspiracy follower, they are crazy when it comes to something like 9/11. And by the way, I do suspect a lot was concealed in terms of administration mistakes surrounding 9/11, but certainly nothing along the lines of Bush being behind it; and mistakes by the administration do not change where the blame fully and squarely belongs- on the hijackers, the Saudis who funded them, those who trained them, Muhammed Sheikh Khalid, and OBL.

Posted by: phx8 at September 6, 2009 9:48 PM
Comment #287627

Just a simple comment about the proposal to allow health insurance to be sold across state lines: I just can’t wait. It worked so well for consumers when the banks were allowed to conduct credit business across state lines. They immediately went to the states with the least consumer protection and those with no or weak usury laws. The health insurance industry will do the same. They will immediately move to states with weak regulation. The result will be cheaper but more limited coverage for the well and young but much more expensive for those at risk or older. That fact is clearly recognized by the authors who propose that states develop high risk pools for those with prexisting conditions and subsidize the high risk insurance. Good idea, the insurance industry gets to insure the healthy and the state the sick.

The second part of the proposal is to eliminate company sponsored group insurance by reducing tax incentives for providing coverage and creating incentives for indiduals to purchase private insurance. This another great proposal that the majority of Americans who receive health insurance through their employer are just waiting to hear.

Posted by: Rich at September 6, 2009 9:59 PM
Comment #287630


Rush is clearly not the head of the party in name or any other way. He doesn’t, as far as I know, hold ANY official title, which is where that word titular comes from. Democrats just want to call him the head so that have somebody to attack.

It would be like Republicans insisting that Al Franken was the head of the Democrats. At least Franken holds a titular office.

Re Van Jones - he was a truther and lots of his statements were racist. Fox News loved him because he was so full of sh*t about white polluters oppressing poor blacks. Google some of his YouTube videos and you will see how weird he is. But he is gone now and we need speak of him no more. I am sure there will be others.

Posted by: Christine at September 6, 2009 10:56 PM
Comment #287632

No, it wasn’t stimulus, Christine. TARP wasn’t a stimulus package.

I do credit Bernake and Paulson for finally waking up once the crisis was laid at their doorstep and dropping the dogmatic responses. Although there are questions about how they handled some situations.

There has been a great deal of action worldwide, other than the stimulus. Read a financial page.

As much as you want to blame the economy on Obama and deflect criticism of Bush’s complete malfeasance, it won’t wash. Even average Americans aren’t that dumb.

This kind of non-reality based thinking is exactly the problem with the Republican party. Repeating talking points and dogma despite the facts, is getting the party and it’s cheerleaders nowhere.

Posted by: gergle at September 6, 2009 11:25 PM
Comment #287641


The Fed pumped up the money supply. That simulates. I understand the political desire to imply that the stimulus plan rushed through congress earlier this year was THE stimulus, but it just is not true.

I refer to this as the second stimulus, describing its true place in the chronology. We can disagree. Maybe it is just my idiosyncratic way of calling things what they are.

I don’t blame Obama for the economy. The economy is much bigger than ANY president or any politics. Politicians can much more easily do harm than good. Their job is long term creations of the conditions for prosperity. They can do little directly.

Obama has not had time to do much damage … or good for the economy. I do fear that the second stimulus will pour too much money into the economy just at the time it is heating up and will create stagflation in 2011. Obama will share the blame for that and he will get even more than he deserves because that is how we misunderstand the economy. Of course, if he wants to take credit for what is beyond his power, he will have to take the blame too.

Posted by: Christine at September 7, 2009 8:39 AM
Comment #287651

“hope that President Obama will be the man Americans thought he was “

The man of hope. I think Americans just wanted a break from oil wars and thought maybe he wasn’t burned out yet.

“health insurance makes no sense. It manufactures nothing”

And yet note the size of the AON building and the John Hancock, now dwarfing the Prudential. It’s not uncommon for people to make a lot of money from manufacuring nothing because some people matter more than others to TIIC.

Posted by: ohrealy at September 7, 2009 2:10 PM
Comment #287679


I’m guessing in your quick perusal of the finance pages you missed TARP1 and TARP2 and the Stimulus package. Different things to most economists, but, yes, it is all about money.

Posted by: gergle at September 7, 2009 8:10 PM
Comment #287681


While in large part I don’t wish to disagree with you, a service is not “nothing”. If I washed your backside, I would create nothing except possibly some sense of comfort on your part (or deeply disturbing nightmares). An insurance contract may do the same thing.

Posted by: gergle at September 7, 2009 8:13 PM
Comment #287684


I am just interested in what things actually DO. I have noticed that is a difference with liberals, who are more interested in naming things. You can call it what you want. The Fed stimulated the economy by creating liquidity. TARP helped shore up financial system. These are things government has the power and responsibility to do. The Fed is the central bank, after all.

The 2009 stimulus gave cash for clunkers and gave money to executives and unions at GM and Chrysler. It is a different, and less effective type of stimulus. Most of that pork still has not been handed out. The cash for clunkers was popular. Everybody like to get free money.

Since you speak for economists perhaps you would ask them to define monetary stimulus.

Posted by: Christine at September 7, 2009 8:57 PM
Comment #287689


My point was and is your “loose” use of terms to say that most of the stimulus hasn’t been spent. Accurate. However, on your new and improved definition of stimulus, you included TARP funds…which HAVE been spent…not getting us into the FED actions and other credit moves.

So, if you are now wishing to retract your first statement…you have my concurrence it was nonsense.

Posted by: gergle at September 7, 2009 9:42 PM
Comment #287693


I supported the first stimulus. It was a bigger deal than most, but falls within what government should do.

Most of the Obama stimulus has not yet been spent. I thought I explained that well enough. If you didn’t get it, let me say it plain.

First stimulus (2008) mostly good
Second stimulus (2009) neutral, not much deployed, maybe bad if causes stagflation.

Posted by: Christine at September 7, 2009 10:04 PM
Comment #287702

Lol, Christine,

I read that like Dana Carvey doing GHW Bush.

I’ll just leave it at, clearly we aren’t communicating here.

Posted by: gergle at September 7, 2009 11:07 PM
Comment #287762

I would rather see the Republicans fight so that Americans can stay Medically Self-Sufficient and Self-Insured instead of buying into the Democratic Argument that every American has to buy health insurance. Yet, I guess that would be hard since they are to busy trying to get Americans to pay more for the Educated Guess of a Doctor and Incompetence of a health insurance ceo.

PS Wouldn’t a Managed Personal Medical Savings Plan backed by Investment of Modern Medical Facilities and Research be one of the best solutions?

Posted by: Henry Schlatman at September 9, 2009 9:04 AM
Comment #287769


I agree that the title of the article is bad. I really just skimmed past the first few paragraphs and started reading carefully when he got to the meat of the article. It’s actually pretty interesting once you get past his attention-grabbing hook.

Posted by: LawnBoy at September 9, 2009 11:30 AM
Comment #287779
as though him being 83 with pneumonia had nothing to do with it.

He did not die of the pneumonia, he died of a HOSPITAL ACQUIRED INFECTION. That needs to be pointed out. With hospitals downsizing their nursing and support staff, patient care is suffering for profit. The bottom line should be patient care, not profit.

Hospital acquired infection is becoming a huge problem. I pray it never affects you or anyone in your family.

Posted by: womanmarine at September 9, 2009 1:38 PM
Comment #287795

Lutheran General Hospital Lutheran General Hospital , now part of Advocate, has expanded so much here that you have to take a bus to get there from the parking lot, and need a golf cart to get around in the buildings. Maybe they’ll end up with moving sidewalks like at Ohare. Security is virtually non-existant, and people wander around at will. They used to own a small thrift store before they became Advocate, but then closed it to get out of providing health care benefits to their own aging employees.

Posted by: ohrealy at September 9, 2009 6:12 PM
Comment #287996

I for one would be delighted to see some proposals on the Republican side. I’m sure they have a lot more to bring to the table than anger and frustration. They might even find that they come up with something the Dems haven’t thought of. I welcome any serious document from our colleagues across the aisle. We have to get over the traditional paradigm whereby one party creates, and the other destroys. Let’s both create together and incorporate the best of both proposals in the final draft.

Posted by: Jon Rice at September 12, 2009 11:38 PM
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