In the Republican presidential debate tonight, Dr. Tim Johnson of ABCNews won the section on healthcare, of which none of the candidates had an adequate response.
Dr. Johnson’s set-up piece made the point that the Republican plans more perhaps more radical than the Democratic plans, in that they attempted to shift people away from group coverage–largely through the employer-based coverage that people have now–into the individual market, via Health Savings Accounts, etc.
Dr. Johnson further gave facts about how individual coverage is more expensive and less efficient–partially because of administrative costs, the inefficiency of having to sell the products one at a time, the lack of any economies of scale, and the inability of the purchasers to leverage their market power to get better cost and quality. He didn’t land the most obvious punch–that many of the Republican candidates, as cancer survivors, would be unable to buy coverage in most states, including New Hampshire (and California), because of their “pre-existing conditions.”
It’s probably the most important distinction between how the two parties view health care. One direction is to expand subsidized group coverage, through employers, public programs, or even a single-payer system. The other is to shift more people in the individual market, leaving consumers at the mercy of the insurers. Guiliani wanted to shift around 17 million to about 50 million buying coverage as individuals– I am not sure those 30+ million would prefer that approach.
Romney came the closest to responding, by saying that the Connector in Massachusetts does provide an opportunity for individuals to take advantage of those efficiencies of group coverage. He’s right. But then he went on to completely misrepresent his own plan in Masssachusetts. He took credit for the fact that over 300,000 people in his home state now have coverage, but then he made a big point of saying it was “private coverage,” which is just untrue. All but a handful of those 300,000 got coverage through the public program expansion for those under 300% of the poverty level.
He mentioned Governor Schwarzenegger’s efforts at health reform in California, not as endorsement, but as a way to say that states should take the lead in designing different plans, and suggested that those that do should get federal funding assistance. That’s helpful to know. But given how all-over-the-place he has been on his own plan in Massachusetts, I am not sure I would take anything to the bank.