Now, finally, the GOP has a "plan" of its own that goes a bit further beyond rhetorical abstractions. As reported and described by the National Journal:
A trio of Senate Republicans on Monday introduced their plan to replace Obamacare with a new system that is built largely around making individuals responsible for a higher portion of their health care costs.
...
In essence, the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or "sensitizing" consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.
Most people don't recognize how much their employer contributes to their health care plan and don't see the costs the insurance company covers: If people are spending more of their own money, many conservatives argue, they'll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more "skin in the game."
Reading the
National Journal report and others, I think that's a pretty fair assessment of the plan's "essence." My sense of it is this: Have consumers (i.e., patients) pay more, and have employers and insurers pay less, thus the system becomes more "patient-centered." Eliminate regulations and consumer protections, leave it up to consumers to protect themselves, thus creating a more "patient-centered" system.
The theory seems to be that if you give consumers more "skin in the game," they'll make better choices about whether, when, where and how to spend their health-care dollar, and the cumulative effect thereof will be to bring costs down. Setting aside the wishful-thinking aspects of this theory, it should at least be pointed out that most consumers are not physicians, medical experts or insurance actuaries. One of the reasons why we have commercial regulation and consumer protection in the first place is that we don't expect people to become experts on everything they might think about buying. For all the braying we hear from the Right about the "nanny state," and the "government telling you what's best for you" and what-not, the fact is that sometimes we do need experts to help us make good choices and prevent us from making bad ones. But I'm not here to launch into a consumer-advocacy dissertation.
What concerns me about this "plan" is that at its core, its "essence" is to require people to take greater risks with their health. Again, the plan is to make people shoulder more of the actual costs of their own medical care, relying less on their employers and insurers to cover them. The purpose of that is to make people more aware and conscious of what their care actually costs, so they'll "be smarter consumers" and "make better choices" in the marketplace. Meaning, and I really can't think of any other meaning, we want people to think twice about seeking medical care when they get sick or injured. We want people to have to decide whether they really, really feel they really, really need treatment and whether it's really, really worth the money before they call a doctor or go to the ER.
I do have to applaud the GOP for coming up with a "plan" that really is an ideological alternative to the right of the ACA. I always understood that the underlying goal of health-care reform was to reduce risk for patients, to give people peace of mind that they can get treated when they get sick or injured and that it won't bankrupt them in the process. Indeed, one of the rationales behind the individual mandate and minimum-coverage regulations in the ACA (you know, the ones that "forced" insurers to "cancel" all those plans that people "liked") is that we don't want people to take risks with their health, and we won't allow people to take risks with their health anymore because when they lose, we all lose. This "plan" that the GOP has come up with does the precise opposite. In encourages, if not outright compels, people to take chances with their physical well-being.
I honestly can't think of another meaning or rationale for the "skin in the game" aspect of the GOP's "plan." The ACA's goal [whether it can or will accomplish same being an open and separate question] is and has been to relieve people of the burdens and risks associated with medical care and its costs; to shift some of those risks and burdens from patients to insurers, employers, providers, manufacturers and government -- all of which are in a better position to bear them than any individual consumer. The goal of the GOP plan appears to be the precise opposite, viz., make individual consumers take greater risks and bear more of that burden, while making insurers, employers, providers, manufacturers, and government bear less of it.
I guess that's what they mean by a "patient-centered health care system."
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