Stanley Feld M.D.,FACP.MACE
Republicans in Congress have introduced their health care reform plan. "The Patients’ Choice Act of 2009," has been introduced by U.S. Senators Tom Coburn, (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA).
The proposal that relies heavily on private mechanisms does not contain an individual mandate to have healthcare insurance, It offers insufficient tax credits for families and individuals previously insured and not in a group insurance plan. It must be noted that people who make less than $38,000 per year pay no income tax. A tax credit is meaningless to them. These are the people who are uninsured.
Individuals not in a group insurance plan pay retail for healthcare insurance premiums with after tax dollars. Employers that have group healthcare insurance for employees, pay the insurance premiums with pretax dollars.
The new Republican healthcare plan would eliminate employers tax deductible benefit. This would discourage employers from providing healthcare insurance to employees. The plan is not dissimilar to the proposal championed by John McCain during the presidential campaign. His proposal was considered inadequate.
“The focus of the proposal is to push for a "guaranteed choice of coverage" in the private market through federal-state partnerships know as State Health Insurance Exchanges.
Individuals will have a "one-stop marketplace" to choose plans in the exchange, including the option of keeping their employer coverage and/or existing insurer.
The plan eliminates pre-tax dollar deduction for employers who provide health coverage to their employees. It provides a $5,710 tax credit to families and a $2,290 tax credit to individuals toward the purchase of health insurance coverage.
This is not enough of a tax credit to be effective for those who can afford to buy healthcare insurance. In reality it will save the government money. It would eliminate employer tax deduction. An unintended consequence will be an increase in thenumber of uninsured.
Healthcare insurance premiums average $14,000 per family and $7,000 per individual. The healthcare insurance industry cherry picks patients. It eliminates the sick and over 55 year olds with a high potential for illness. If its ability to cherry pick is eliminated the healthcare insurance premiums will be even higher.
The Republican healthcare plan does not state if the non insurable sick will be subject to the same or higher premiums.
"Participating insurers," meanwhile, would be required to "offer coverage to any individual — regardless of patient age or health history" though there is no mandate for an individual to purchase that insurance”.
Many things are wrong with the Republican party’s proposal. I am disappointed in Senator Tom Coburn. He is a “practicing M.D” he should know the real problems in the healthcare system..” The proposal has some good ideas but no suggestions on how to implement those ideas.
His plan ignores the real problems. The uninsured cannot afford to purchase healthcare insurance. Some young healthy people do not want spend the money for healthcare insurance. Many people are underinsured. Illegal immigrants are uninsured. They show up for care in our safety net hospitals. Our safety net hospitals are underfunded. The plan does not contain incentives for patients to work hard to remain healthy.
The reasons healthcare costs are so high are many. Price Waterhouse has calculated 1.1 trillion dollars is wasted dollars between defensive medicine and unnecessary administrative cost.
Medical care for the complications of chronic diseases absorbs 80% of the healthcare dollars. The complication rate can be reduced by at least 50% if patients became “professors of their disease” and they themselves prevented the complications. This can only be accomplished through education and financial incentives.
The proposal does not repair any of the abuses of the healthcare insurance industry, the government, the hospital systems or physicians.
The proposal gives employers a perfect excuse to drop insuring employees by the removal of their tax exemption for premiums. President Bush tried very hard to accomplish this and failed. .
The Republican plan would leave a greater number of Americans uninsured with no improvement in the health of the nation.
The Patients’ Choice Act contains many of the popular sound bites. It does not have a plan to achieve change. The only way change will occur is by leveling the playing field and providing incentives for patients. The plan keeps the healthcare insurance industry in control of the healthcare dollars.
It states; “ the Act transforms health care in America: strengthening the relationship between the
patient and the doctor; using the forces of choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans.”
I am disappointed in the Republican proposal. It is a proposal of empty words. The public will not be fooled. The public wants change. I will publish the executive summary so readers can judge for themselves.
Under the Republican plan, instead of a competitive marketplace for healthcare coverage I can visualize a market place dominated by a few healthcare insurance companies. The result will be further increase in cost of premiums. The healthcare insurance industry would continue to own the healthcare dollar and be non transparent.
The healthcare insurance industry would continue to abuse patients, physicians, hospitals and the government.