Governor Jindals' health care proposal

The Republican Governor of Louisiana, Bobby Jindal, proposed the following for a national health-care policy:

Insurance reform. Congress should establish simple guidelines to make policies more portable, with more coverage for pre-existing conditions. Reinsurance, high-risk pools, and other mechanisms can reduce the dangers of adverse risk selection and the incentive to avoid covering the sick. Individuals should also be able to keep insurance as they change jobs or states.

Problem: The failure to provide "more coverage for pre-existing conditions" is not, as the computer guys say, a bug, but a feature of private, for-profit health insurance. It's an inherent, built-in tendency that no "guidelines" will ever eliminate from the picture. It is in the financial interests of these companies to not pay claims. Nothing will ever "fix" that as asking them to ignore that fact is to ask private, capitalist companies to disregard their very nature.

Consumer choice guided by transparency. We need a system where individuals choose an integrated plan that adopts the best disease-management practices, as opposed to fragmented care.

If it were in the financial interest of private, for-profit companies to provide such transparency, they've had decades to provide it. If there is no such transparency currently being provided, there's very probably a good (financial) reason why not. It's very highly likely that even if such transparency is mandated, companies will find ways around it, thereby making phone-book size regulations inevitable. BTW, the Blue Dog Democrats are no better on the issue than Republicans are. Again, their reasons are mostly financial.

Aligned consumer interests. Consumers should be financially invested in better health decisions through health-savings accounts, lower premiums and reduced cost sharing.

Lower costs are precisely what's being offered by the Democrats.

A new study from the Commonwealth Fund finds that the public option could save the country $265 billion. The same study found that Grassley's favored approach--allowing insurance companies to maintain their near-monopoly status--would cost the country $32 billion.

In short, Jindal is offering absolutely nothing that even begins to address the problems caused by overreliance on private, for-profit health care insurance. What are his critiques of the Democratic approach?

Second, the Democrats disingenuously argue their reforms will not diminish the quality of our health care even as government involvement in the delivery of that health care increases massively. For all of us who have seen the Federal Emergency Management Agency’s response to hurricanes, this contention is laughable on its face.

Keep in mind that in August 2005 when Hurricane Katrina hit New Orleans, the Presidency, the Senate and the House were all in Republican hands. Louisiana Governor Kathleen Blanco declared a State of Emergency on Friday, 26 August. President Bush was fully and properly informed by the Governor on Saturday, 27 August that Federal assistance was required. The hurricane struck late on the night of Sunday, 28 August.

8PM CDT [Monday 29 Aug]— GOV. BLANCO AGAIN REQUESTS ASSISTANCE FROM BUSH: “Mr. President, we need your help. We need everything you’ve got.” [Newsweek]

LATE PM — BUSH GOES TO BED WITHOUT ACTING ON BLANCO’S REQUESTS [Newsweek]

New Orleans was not submerged because "government" was inherently incapable of action. It was submerged because the government was in the hands of people who didn't believe they were responsible for assisting their fellow citizens in a crisis.

Far better examples for Jindal to use to look at how the government would handle health care would be to look at institutions like the VA Hospitals (I stayed in two VA Hospitals in 2000 and was satisfied with their services) and the Post Office (The number of letters that I didn't receive despite their being properly addressed, I can count on one hand).

Republican Representative Michele Bachmann agrees with Jindal's first point, that

If a so-called public option is part of health-care reform, the Lewin Group study estimates over 100 million Americans may leave private plans for government-run health care.

See above, where I explain that private, for-profit companies will inherently and by definition, always seek to pay out as few claims as they can possibly get away with. A government plan will not have that incentive. Note Bachmann's reasoning as to why a government plan will be less expensive:

...because the taxpayer-subsidized plan will be 30 to 40 percent cheaper.

Not because the government can make it cheaper, as Jindal claims it will unfairly do, but it will just be inherently cheaper as the government pays their senior people far less than executives at private companies make and the government doesn't have to pay for advertising or any other type of competition with other providers.

In short, Jindal makes an extremely unconvincing case for maintaining private, for-profit health insurance. I recommend "single-payer" and believe that "public option" would be a reasonably satisfactory substitute, at least for now.