I'VE PROMISED TO RATE the Republican plan on the democracy scale, as well, but before I do that I need to be clear about a fundamental difference between that plan and both of the Democratic plans.
The Democrats are writing real legislation. They fully expect it to become law. Because of this, they have had to consider all sorts of things that the Republicans didn't.
They have had to worry about practical matters, guarding against problems a policy change could trigger. They have had to worry about getting enough votes to pass the bill.
All of these things make the bill longer and more complicated. All of them make it less ideological.
The Republican plan, by contrast, was never expected to become law.
Its authors could ignore many pragmatic problems, and didn't have to make any compromises to win votes which they never expected to get.
The result is that the Republican plan is probably a better reflection of the ideology of its authors. It won't tell us, as clearly as the Democratic bills do, what Republicans might really pass given the chance, but it will tell us what they would most like health reform to look like.
The question I will be asking of the Republican plan is the same one I asked of the Democratic plan—In what direction does it shift power?
Toward big corporations and the wealthy (capitalism)?
Toward government ownership of the entire process (socialism)?
Or toward the ordinary citizen (democracy)?
The four reforms which Republicans emphasize in the bill are:
-
Let families and businesses buy health insurance across state lines.
This sounds, on the surface, like a great idea which would move power towards the people by allowing them greater choice.
Unfortunately, it's exactly the opposite.
Under the present system many states have passed laws protecting their citizens from abuses by the health insurance companies.
If a company wants to do business in their state, it has to abide by those rules.
This provision, which is framed as freedom for the consumer, is actually a measure which would simply allow your insurance company to move to another state without those restrictions.
The net effect is that the states with the least restrictions would quickly become the only states with insurance companies.
Why would a company stay in a state that has rules it would like to break when it can still sell to the citizens of that state from the state next door?
The net effect is to take away your legal protections, and give more choices to the insurance companies.Provision Moves Us Toward Direction Out of State Sales Capitalism, Corporate Power over citizens - Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.
Much like the first provision, this one is framed to sound like a gift to the consumer, while it is actually a gift to insurance companies.
Because these health pools allow individuals from different states to buy as a group, they are exempt from state regulations.
Again, the primary agenda is to eliminate state controls on insurance companies, and to remove protection for the consumer.Provision Moves Us Toward Direction Insurance Pools Capitalism, Corporate Power over citizens - Give states the tools to create their own innovative reforms that lower health care costs.
This one is meaningless.
The bill provides incentives to states, but the first two provisions guarantee that no state will actually have any control over health care insurance.
The net effect is to make this provision an empty propaganda claim.Provision Moves Us Toward Direction Insurance Pools Capitalism, Corporate Power over citizens NONE
- End junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it's good medicine, but because they are afraid of being sued.
Like the first two provisions, this one is aimed at taking power away from the states, by overriding state consumer protection laws.
Frivolous lawsuits do happen, and they do cost money, but not enough to make an important difference in health care costs.
The down side, of course, is that the provisions limits your right, as a citizen, to take a company to court if your rights have been violated.
That right is useful to you, and gives you more options, even if you never use it.
The fact that an insurance company knows you can sue makes them think twice about how they treat you.
Republicans would like to remove that constraint on insurance companies, and thereby move some of the bargaining power from you to them.Provision Moves Us Toward Direction Limit Lawsuits Capitalism, Corporate Power over citizens
Three of the four provisions move power toward the corporations, and one has no real effect because of the others.
The provision probably would lower insurance costs, according to the Congressional Budget Office, but at the expense of less coverage.
In other words, the plan would provide slightly cheaper, and less effective, health care for the average citizen, and reserve high-quality heath care for the wealthy.
The net movement of power in the Republican bill:
As I said at the beginning of this post, the Republican bill, because it didn't have to deal with the problem of getting actual votes, is a clear indicator of what the party would like to do.
Given a chance, Republicans would like to give the wealthy and corporations more power over health care, and the average citizen less.
Next time: a final comparison
of the plans...
