The GOP Reform Plan

So, I'm reading over the GOP health reform plan from June 2009. Some thoughts:

--Tax savings for those who provide their own health insurance will not help if you cannot pay for your own health insurance.

--Will providing tax credits really be enough to account for the full cost of health insurance? If not, then the tax credits may have no impact on the availability of coverage.

--If insurance companies are allowed to pool their insured customers across state lines, which state's rules apply? Each state has an Insurance Commissioner who decides what coverage and obligations are required. If an insurer has a product that is sold in multiple states, will they be able to use the least restrictive rules? In that case, will there be a race to the bottom in which the only affordable insurance plans available are those that offer the fewest benefits and the least coverage?

--I agree that medical liability and tort reform would be nice. As a physician, I would be very happy not to be burdened by ever-increasing malpractice costs. Medical malpractice caps do limit the malpractice costs for physicians, but there is little/no evidence that it stops physicians from over-ordering tests or that the cost savings are passed along to patients or to the system as a whole. So--malpractice and tort reform would be great, but will not really fix the system. Including this reform might be best used to help get physicians on board, but not to remedy any real problems. [The way to stop over-ordering might be to allow physicians to see fewer patients and spend more time with each patient--a good history and physical exam could save a lot of tests--without going broke or out of business.]

--I do not see how health savings accounts (HSA) will help people who are too poor to save money. No-one has yet explained to me how patients whose incomes are used up by their bills and other obligations are supposed to benefit from access to an HSA unless someone is putting the money in on their behalf.

--Making health insurance portable and guaranteeing health insurance to all regardless of preexisting conditions: both already in the proposed legislation.

--Has the GOP paid any attention to the fact that health insurance costs are severely limiting business's ability to compete in the global marketplace? Are the proposed tax credits going to be enough to balance this out?

--Expanding SCHIP programs and allowing minors to stay on their parents insurance plans for a longer time: already in the proposed legislation.

--Enhancing incentives to enter primary care and promoting community health centers as an accessible model of care: already in proposed legislation.

So, one big missing piece: nowhere do I see any mechanism for controlling insurance costs. In the the current proposals, the public option would provide a means for controlling insurance costs. Under the GOP plan, is this supposed to magically appear as a gesture of goodwill on the part of the insurers? Or is a health insurance exchange going to help moderate costs (you know--like the exchange in the currently proposed legislation)?

I don't see how the GOP plan actually expands care to those who lack access now and I don't see how it makes health insurance more affordable.

It's a little like Medicare Part D (the drug coverage plan passed in the Bush years). This plan specifically restricted the government Medicare program from negotiating prices with drug companies. So, as a result, the program has been tremendously expensive for Medicare and a windfall for big pharmaceutical manufacturers while not providing maximal benefits to patients. The GOP healthcare refomr proposal would give patients and businesses tax credits to buy private insurance, in effect rewarding the very same companies that have failed us thus far.

Passing along public money to improve private companies' bottom lines. We've seen this show before, and it never ends well for us.