Congressional Republican's Healthcare Reform Questionnaire

I live in the Pittsburgh are, specifically in Republican Congressman Tim Murphys's district.

Today we received an "Important Survey on Pending Healthcare Legislation" from the Congressman. I was impressed by the straight forwardness of the questions (the subtle subtext was that you must be a complete moron to want our health care system to change) and by the clear headed, willful ignorance of the actual issues involved in reform displayed by the survey writers.

And awaaay we go...

Okay, in fairness, the first six questions weren't bad: do you have insurance, what kind, how is it, is it getting more expensive, do you believe the system is broken, and what priority should it be for Congress.

7. Do you favor a healthcare system that is run by the private sector or the government? (Private, Govt, combination, unsure)

Let's see, I want the highest quality system in the world with costs far lower than our current system. Looking around the world I see that France, a government administered single payer system is the best in the world, and Germany, with a government regulated social health insurance system administered by private, not for profit insurers is right behind it. Low cost, high quality, waiting times like ours are now... OK, I choose either Government Run like France or a Hybrid system like Germany's.

8. Would you be willing to pay higher taxes to guarantee heath insurance for all Americans?

This is why I'm writing this diary, because this question always sets me off. I would be willing to pay higher taxes because, if we do this correctly (see question 7), I will no longer be paying insurance premiums. If we do it really well (see question 7), I will actually end up paying significantly less for my healthcare overall, because we will eventually squeeze out the tremendous waste, overhead, and obscene profit currently embedded in our system.
What really ticks me off about this is the blatant intellectual dishonesty (or it could be simply ignorance, I can be charitable) on display. It does not require a degree in economics to understand that we pay for health care in many ways, but primarily we pay for it through our compensation packages: our insurance premiums come out of our wages! Ask anyone who's had stagnant wages over the past decade whether or not health care costs come out of their wages.
Have no republicans *ever* looked at a study on comparative international health care? Do they not know that we pay way more than any other country in the world. Per capita, as percentage of GDP, however you want to slice it: we have the most expensive system on the world and the Republicans seem to think the only fix is to add costs?

9. Do you think a private sector healthcare system can be improved to provide coverage to more Americans at a lower cost than a nationalized plan?

I have to confess my initial impulse was a *big NO*, but, thinking of Germany, Switzerland and the many other countries using a hybrid public-private system of Social Health insurance, I will answer a qualified yes.

If we follow the models provided for us around the world and regulate the private insurers (i.e., a 3 or 4 millimeter long leash), it can be done. The discipline that would be required for our Congress to resist the money that would surely be thrown around does make me despair that it is near impossible. But, it has been done the world over, so, I can dream, can't I?

Germany, again, provides an interesting model because it uses private, but not for profit, insurers (sickness funds) to do the administration. Everywhere in the world but here, not for profit means not for profit and not for profits don't accumulate billions in "reserve funds" or pay executives millions of dollars a year.

10. What is your main concern with your current health insurance coverage or plan? Not portable/tied to employer, lack of transparency, too many restrictions on providers/rationing, out of pocket expenses, or other.

Props where they are due for this question. I hope his Democratic constituents give him an earful on these! All of the above is the obvious answer for me, but I just have to take up the choice/rationing bit.

Republicans are always focused on choice of insurer or of insurance plans, as if where you go to the hospital or which doctor you go to is an afterthought. Like every major market in the country, Pittsburgh has essentially 2 insurers. We switched plans a couple years ago *within* one of those insurers and we went from having my wife's skin cancer specialist on one plan to her breast specialist on the other. But at least I could choose my plan!

My prior manifesto on rationing is here.

11. Should the government require that every American have health insurance?

Germany requires everyone in the bottom 4/5ths income to participate in a sickness fund. The upper fifth can opt out: 3/4 don't, leaving the wealthiest one fifth in the private market. I can live with that.

Single payer countries, you're just in. Period.

Either works for me.

12. Should the government require that all health insurance companies provide a "Basic Plan" option...so that families could shop around?

Not the ultimate solution, but since something like this will probably find its way into the reform, here is my proposal. it comes from an old Adam Tobias book on the insurance industry called "The Invisible Bankers."

I'd like a truth in insurance statement, like a truth in lending statement on a loan or, even better, an energy sticker on an appliance. I can imagine lots of information on this sticker, but the really interesting one would be the one I stole from Tobias: *"This policy, on average, will pay out xx cents on every premium dollar paid."* I'll leave you to cogitate on that.

13. Should the government create and manage a public health insurance plan that would compete for business alongside private insurance plans?

If you've read this far, you know my answer: Well, it's better than nothing!. But, seriously, considering how un-progressive this legislation is going to ultimately be, we have to draw a line in the sand somewhere, and this should be where we draw it *at an absolute minimum.*

14. Should people on Medicaid have the option of purchasing private health insurance with a voucher to shop around for the best coverage, rather than have only the option of government insurance?

I happen to think Medicaid has lots of problems. Not the least is its very low reimbursement rates in many big states resulting in de facto rationing.

So I am against using Medicaid as the vehicle to expand coverage, but I know others feel differently.

15. Should the government offer tax credits to individuals to help offset the cost of health insurance?

I think the phrase "magic bullet" must have been invented just to cover the Republican love affair with tax cuts. Or that one about having only a hammer as a tool and every thing looking like a nail. One of those.

16. Should the government allow individuals to purchase health insurance from any state and shop nationally for the best price?

Don't care, won't help, but I can't help but notice that on issues of privacy, national security and torture, republicans say "we," but on social justice issues, it's "the government." Just sayin'.

17. Should the government mandate that private insurance companies cannot turn away patients with pre-existing conditions?

I'll vote yes, but it provides a teaching opportunity. What happens in Germany or Switzerland, you may ask, if a particular insurer gets a disproportionate care of sicker patients who cost them more? Since they can't charge higher premiums based on this and can't drop people, what happens? Risk adjustments are made and the companies get adjusted funds from the government. This is being proposed here, as well.

And finally, just to remind the pipples why they hate government and really hate all this "social justice" nonsense that the Pope and Winston Churchill are so hopped up on:

18. Any government assistance will require taxpayer funds to cover the cost. Which of the following proposals would you support to pay for health care reforms, and for the government to cover the uninsured?(nat'l sales tax, higher payroll taxes, marriage penalty, cell phone taxes, sin tax on soda, sin tax on alcohol, tax on charitable donations,raise income taxes, penalize employers for not providing insurance, tax on insurance, tax on health care expense, tax on future health care needs (?), tax on Rx drugs, raise taxes on oil refineries, taxes on power companies, taxes on US companies doing business overseas, taxes on dividend income, raise capital gains taxes, inheritance tax - phrased "tax you family assets on death" LOL.

So, if you weren't steamed before, I bet you are now. I refer you back to answer 7 for the inanity of this question, but in the best Republican tradition of ginning up resentment among the citizenry, I give you, "the list."

Cheers,

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