Wednesday, February 10, 2010

Gingrich & Goodman Idea #1: "Make Insurance Affordable"

The first idea proposed by Gingrich and Goodman as a "GOP health idea" is to "Make insurance affordable". I mean, wow. It's so simple. So elegant. So... platitudinous. It's fair to respond that the Democratic bill shares that goal.

Gingrich and Goodman complain that the current approach to taxing health insurance is "arbitrary and unfair", whining about "Cadillac plans" (the type of plan that they, themselves, likely enjoy through their own employment) getting a big subsidy while people buying their own plans get almost no tax break. They claim that "More equitable tax treatment would lower costs for individuals and families" - true. You could give everybody the same tax break, and suddenly insurance would be more affordable for those buying their own plans. Which, of course, is why Gingrich and Goodman immediately drop that ball - that's certainly not the type of tax equality that they want.

They then engage in an appeal to authority - not a specific authority, but an unnamed authority. "Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased." That sounds a lot like the tax credit idea floated by John McCain during his presidential run. But here's the thing - the goal of that proposal is not to make health care more affordable. It's about limiting the benefits available through health insurance policies, by discouraging employers (save, of course, at the executive level) from offering comprehensive insurance plans. By failing to identify the economists behind their appeal to authority, Gingrich and Goodman avoid the other side of those proposals - that vocal proponents of that particular reform (like Gingrich himself) propose this idea with the goal of reducing the number of people who enjoy comprehensive health insurance.

By putting the words into the mouths of "many health economists", Gingrich and Goodman cleverly avoid endorsing the idea themselves. Why not "We agree with those health economists who argue..."? For that matter, how about explaining how representative those views are among health economists (does "many" mean 3%, 30%, 60%), and why as can be reasonably inferred do "many" health economists reach other conclusions.

Moreover, if this is truly a GOP goal, where are the GOP voices in favor of the current Senate bill, that includes a surcharge on high cost plans. That could be treated as a starting point for phasing out the subsidy for employer-based coverage. Gingrich knows enough about Congress to understand that the tax subsidy is not going to be wiped out overnight, or even over a few years, so it's dishonest of him to suggest that the GOP would somehow be able to do something dramatically different than what the Senate Democrats have proposed.

Finally, if we truly are talking about "fairness" here, we could decide as a nation, "Here's the minimum amount of insurance coverage a person should enjoy in our society," then attach a dollar figure to that coverage. Note that although Gingrich likes to pretend that the amount should be equal across the nation, if you know anything about health insurance you know that the cost of similar coverage will vary depending upon your geographic location. Once that amount is determined, people could be issued a tax credit in that amount to cover the cost of their basic policy. Or we could develop a national insurance plan that covers those basics and not have to worry about tax credits. That would provide everybody with equal, reasonably priced insurance, and anybody who wanted more could turn to the private market.

Fair, affordable, and... well, let's be honest. Although it's entirely consistent with what he writes in his editorial, were such a policy implemented Gingrich's head would probably explode.

A cogent case can be made for why the present system of tax subsidies for health insurance is unfair, why equal tax benefits should be extended to the self-employed, why phasing out the subsidy may be good tax policy and how doing so may help untether people who need continuity in their healthcare coverage from a particular employer. But those issues don't appear to be of great interest to Goodman and Gingrich. Even if you have missed Gingrich's prior commentary on the subject, it is patent from the balance of their editorial that the goal here is to "make insurance affordable" by giving people less insurance coverage. It's likely under Gingrich's various plans that this is "less is more" turned upside-down - you get less coverage for more money than an equivalent plan would currently cost. But it's "affordable" because you get a lot less coverage and thus still costs less than your current comprehensive health insurance plan.

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