Tuesday, November 29, 2011

Not a flip-flopper like that Romney

Newt Gingrich, 2011:
I wouldn't lie to the American people. I wouldn't switch my positions for political reasons.
Newt Gingrich, 2005:
If I see somebody who's earning over $50,000 a year, who has made the calculated decision not to buy health insurance, I'm looking at somebody who is absolutely as irresponsible as anyone who was ever on welfare. Because what they've said is, A, I'm gambling that I won't get sick, and B, I'm gambling that if I do get sick, I can cheat all my neighbors. Now, when you talk to hospitals, a very significant part of their non-collectibles are people who have money, but have calculated it's not worth the cost to pay. And so I'm actually in favor of finding a way to say, whatever the appropriate level of income is, you ought to have either health insurance, or you ought to post a bond. But we have no right in this society to have a free rider approach, if we're well off economically, to cheat our neighbors.
I'm sure Newt had excellent, non-political reasons for saying this in 2005 and presently condemning Obama as a socialist for the PPACA's insurance mandate.

(It's not a total "gotcha" by any means; one could like the mandate as a policy, but think it unconstitutional. But somehow I suspect that is not Newt's position.)


  1. One of the problems with both Obamacare and Romneycare is that they tend to dictate exactly what health insurance is to be purchased. And there is no option to post a "bond." I read about one poor woman in Massachusetts who had a severance package that gave her a lifetime of free health insurance. But it had a $1,500 deductible, and Massachusetts didn't allow any policy with more than a $1,000 deductible. So this woman was forced to pay a fine or double insure.

    Obamacare essentially micro-manages the choices that people can make. Give people the option to partially self-insure and I'm far more likely to support a mandate that would cover catastrophic care.

  2. they tend to dictate exactly what health insurance is to be purchased

    Well, yes, because purchasing shoddy insurance is like purchasing no insurance at all.

    And there is no option to post a "bond."

    Pay a fine, pay a bond -- the difference seems immaterial, and god knows how that bond thing would work.

    Anecdotes about people injured by the system are fairly worthless with any large program. Certainly there is a lot more harm from the # of uninsured than from any bad side effects (which can and should be ironed out with experience).

    I'm far more likely to support a mandate that would cover catastrophic care

    That's an arguable and attractive position, but our market is so heavily deformed by the insurance model that ordinary care can become "catastrophic" for the uninsured. You can't get a hospital to charge the same rate for the same procedure.

    And getting people insured makes preventive care more feasible, which is the better end of the stick to work on, rather than catastrophic coverage that comes too late for a good health consequence.

  3. Most catastrophic health expenses can be avoided by regular primary care for chronic diseases, e.g., asthma, diabetes and hypertension, along with currently recommended surveillance for things like breast, prostate and colon cancer. With a broad-based tax of around 3%, the US could finance universal primary care and catastrophic health insurance. (This is the plan in Australia, for example.)

    The catastrophic coverage could be indexed to income via a stop-loss provision, similar to the lower limit on deduction of medical expenses in the current tax code (7.5% of adjusted gross income). This gap could be covered by supplemental insurance like Medicare currently operates.

    People would also be free to purchase better, i.e., more comprehensive coverage on the open market, subject to exclusionary underwriting by the insurers, while being assured that -- even if they are otherwise uninsurable -- they will still have coverage for chronic conditions and catastrophic illness or injury. Insurers would be able to price this coverage more affordably by coordinating their coverage with the basic universal plan. Alternatively, the government could realize a savings by establishing the universal plan as a payer of last resort, as with the current Medicare secondary payer provisions.

    There are a lot of ways to improve the Affordable Care Act. Most of them involve some single payer provision, which is anathema to the Republicans, even though it would benefit their donors in the insurance industry. Even a modest expansion of Medicare, say to cover those 55 and older, would be of overall benefit by putting some younger, healthier people in the Part B pool (which is at least partly funded by premiums paid by the participants).

  4. It all sounds good, but unfortunately we can't have a sane discussion in the present policy environment; the GOP stopped reading your comment at the word "tax."

  5. SOMS is onto something those of us in healthcare have been saying for years. It is not the total amount of money being spent in the US, it is where it is being (mis)spent. Primary care is the most inexpensive component in a cost-benefit comparison of healthcare costs. The US economy spends more than enough money already, just in the wrong categories. SOMS breaks it down in precisely the correct language, but Anderson is on point by stating the word *tax* is not the way to get a consensus in Congress on approving a common sense approach to addressing this evergrowing problem.

  6. The US economy spends more than enough money already, just in the wrong categories.

    That's my understanding too. Arguably, Medicare had a distorting effect on the nation's healthcare; we're focused much more on heroic end-of-life care than on earlier prevention & primary care. (Cue "teh death panelz!")