Wednesday, February 10, 2010

Gingrich & Goodman Idea #3: "Meet the Needs of the Chronically Ill"

A third "idea" that Newt Gingrich and John C. Goodman claim belongs to the GOP is the idea that health insurance should "Meet the needs of the chronically ill". You know, sometimes it's better to admit you only have nine ideas than to claim that the Republican Party is more concerned than the Democrats about people suffering from chronic illness. What does Gingrich propose?
Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.
If the GOP were to write up a simple bill encapsulating this proposal, overlooking the fact that it would likely increase healthcare expenditures, I expect that the Senate would pass the bill by a very wide margin, with most of the "nays" likely to come from the Republican side.

What does Newt have in mind? If you recall, one of his goals is to deny coverage for routine medical care, such that you would have to pay for that care out-of-pocket. This proposal is apparently meant to soften the impact of the fact that many chronically ill people will not be able to afford the care they need if Gingrich's dream comes true. So instead he imagines them being given medical devices and trained to "be in charge of their own care", while pretending that his goal is to empower them.

That's not to say this is a bad idea, or shouldn't (to the extent possible) be implemented without gutting health insurance coverage. But there's another side to this: if there were substantial cost savings to be achieved, health insurance companies should be more than happy to implement this idea without any prodding from Congress. And in fact, when it is economically viable, the chronically ill are given the tools they need to administer insulin, breathing treatments, and other treatments that they can reasonably perform at home. It also follows that, to the extent that it is not done, it's because their actuaries don't project a cost savings.

The question thus becomes, are Gingrich and Goodman making this proposal because they seriously want to empower patients even though it will increase healthcare costs, are they making this proposal because they want patients to be empowered to the maximum extent once the device and home-based care are no more costly than the status quo, or are they making this proposal because they want to put a friendlier spin on what prior editorials suggest to be Gingrich's goal - making patients responsible to buy the machine from health savings accounts (if they actually have health savings) with the consequence of their failing to do so (or inability to do so?) meaning that they either forego the care or pay out-of-pocket? Because, as I suggested before, it's only for that third option that they should not be able to easily construct and pass a bipartisan bill.

Consistent with that inference, Gingrich and Goodman propose that those with chronic illnesses can be allowed to self-manage their care through "Health Savings Accounts". They hold up as an example a program operated by Medicaid. So are they advocating "Medicaid for all", at least for basic care and for the disabled? Of course not.

Their contempt for community rating is made plain in their last "reform" proposal, having insurance companies "specialize in managing chronic diseases" so that healthier people can obtain cheaper insurance from non-specialist carriers. They argue, "This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted" - but no, what it will do is guarantee that you don't have insurance for your chronic illness if and when you develop such an illness. After all, everybody gets sick at some point, and everybody dies. The Gingrich/Goodman plan seems intent on making sure that you bear that cost out-of-pocket (if you can afford it) rather than spreading the risk through insurance - despite the fact that the purpose of insurance is to spread risk.

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