The Republican Party’s “No” Line On Health Care

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It is easy to imagine Rahm Emanuel chuckling when he read the Republican Party’s new statement of principles for health care reform, which were released Monday. Like Democrats who decided in 2005 to oppose President George W. Bush’s Social Security reforms without offering any real constructive counter-proposal, the Republican Party, under the leadership of Michael Steele, has laid out a strategic plan for health reform that is entirely negative in its substance. (It is also rather misleading, as the head of the AARP explains here.) The GOP has embraced, apparently, Emanuel’s claim that it is the “party of no.”

Steele lays out six principles, which are clearly written for their political effect, which I expand upon after the jump.

1. No cuts in Medicare, a government-run program Republicans like, which Steele admits is going “into the red in less than a decade.” (Does this mean that Republicans now support tax increases to pay for the shortfalls? Or that there is no solution? Or that something else should be cut? What?)

2. No expansion of government-run healthcare, which could involve “boards that would decide what treatments would or wouldn’t be funded.” (Left unmentioned is the fact that such boards already exist in the private health care marketplace, and, in practice, in the Medicare system, which, in the words of its own website, “does not cover everything, and it does not pay the total cost for most services or supplies that are covered.”)

3. No efforts to ration care based on age. (Left unmentioned is the fact that no one in the Democratic Party has proposed this. The citation most-often made for this piece of misinformation is to a paper by Ezekial Emanuel, a White House adviser, which discusses age-based rationing for a select group of cases in which there is an absolute scarcity of resources–like organ donation, or vaccine distribution. In the very paper, which has no connection to the current health reform legislation in Congress beyond Emanuel’s authorship and the fact that he works at the White House, Emanuel says it would be inappropriate to apply the age-test to health care generally.)

4. No government interference with end of life care. (Left unmentioned is the fact that Democrats only want to allow for Medicare reimbursement of end of life consultations, which can reach any conclusion, including the decision by patients to ask for every possible treatment. This raises a philosophical dilemma: Is the government interfering by not allowing doctors to be reimbursed for speaking with their patients, or is the government interfering by allowing doctors to be reimbursed for discussions with their patients? If we follow the logic of #2 (see above), “not interfereing” would probably be giving patients more options, not less.)

5. Not cut the Medicare Advantage Plan. (Left unmentioned is the fact that Medicare Advantage provides a subsidy of about $17 billion a year to private insurance companies to offer services that would otherwise be offered by Medicare. The LA Times has a good explanation of this debate here.)

6. No increased costs for veterans under Tricare. (Left unmentioned is the fact that, though final reform proposals have not been formulated, HHS Secretary Kathleen Sebelius has said that Tricare would not be impacted. Last week, in Arizona, President Obama said, “Since there’s been so much misinformation out there about health-insurance reform, let me say this: One thing that reform won’t change is veterans’ health care.”)

The Steele document is a political document, designed to kill Obama’s health care plan and increase Republican odds for the midterm elections in 2010. On that front, it is probably a smart move. But as policy, it has little merit. It offers no positive proposal to deal with the spiraling costs of health care, which Steele admits need to be dealt with, and it offers no suggestion about how to broaden coverage. Other Republicans have put forward proposals to deal with the hard policy issues. But they now belong to a party that is focused not on policy reform, but on winning the fight.