Examining the Republican Platform Part VI: “Health Care Reform: Putting Patients First”

This is continued from Parts I-V of my examination of the Republican Platform. I say I made good on my guarantee because this is before I went to bed.


The rest of the Republican platform deals with social issues, starting with Part VI, "Health Care Reform: Putting Patients First", which will cross over with the Democrats' favorite topic. The Republicans' treatment of it begins with empty praise for the personnel and resources of the medical system, and the need "to build around them the best health care system. Republicans believe the key to real reform is to give control of the health care system to patients and their health care providers, not bureaucrats in government or business." Does that mean you would junk the current private health care system that even Democrats want to retain? Is this something where privatization is not the answer?? Here are the problems the Republicans see with the current health care system:

• Most Americans work longer and harder to pay for health care. 
  
• Dedicated health care providers are changing careers to avoid litigation.
  
• The need to hold onto health insurance is driving family decisions about where to live and work. 
  
• Many new parents worry about the loss of coverage if they choose to stay at home with their children.
  
• The need – and the bills – for long-term care are challenging families and government alike.
  
• American businesses are becoming less competitive in the global marketplace because of insurance costs.
  
• Some federal programs with no benefit to patients have grown exponentially, adding layers of bureaucracy between patients and their care.
  

Gotta love the shots taken at trial lawyers and the size of the bureaucracy. The Republicans claim "It is not enough to offer only increased access to a system that costs too much and does not work for millions of Americans. The Republican goal is more ambitious: Better health care for lower cost." Your stance intrigues me, and I wish to learn more.

"First Principle: Do No Harm": "The American people rejected Democrats' attempted government takeover of health care in 1993, and they remain skeptical of politicians who would send us down that road.  Republicans support the private practice of medicine and oppose socialized medicine in the form of a government-run universal health care system.  Republicans pledge that as we reform our health care system:

• We will protect citizens against any and all risky restructuring efforts that would complicate or ration health care." The Republicans seem to think it's impossible to "cover all", as the Democrats want, and still offer complete coverage, as the Democrats want. Not sure how the Democratic plan would really "complicate" things – you choose between a number of providers.
  
• "We will encourage health promotion and disease prevention." So do the Democrats; this is presumably a defense against the notion that they wouldn't do those things.
  
• "We will facilitate cooperation, not confrontation, among patients, providers, payers, and all stakeholders in the health care system." I'm intrigued as to how.
  
• "We will
  not put government between patients and their health care providers." Unless "health care providers" refers to private insurers instead of doctors and hospitals, I'm not sure how the Democratic plan "puts government between patients and their health care providers".
  
• "We will
  not put the system on a path that empowers Washington bureaucrats at the expense of patients." Fair point.
  
• "We will
  not raise taxes instead of reducing health care costs." The Democrats did say their rollback of the Bush tax cuts would pay for their health care plan, but they are also concerned about "reducing health care costs" if I recall correctly.
  
• 
  
  "We will
  not replace the current system with the staggering inefficiency, maddening irrationality, and uncontrollable costs of a government monopoly." Given some of the weak spots in the Democratic plan, fair point.

  Radical restructuring of health care would be unwise.  We want all Americans to be able to choose the best health care provider, hospital, and health coverage for their needs.  We believe that real reform is about improving your access to a health care provider, your control over care, and your ability to afford that care. 

  We will continue to advocate for simplification of the system and the empowerment of patients.  This is in stark contrast to the other party's insistence on putting Washington in charge of patient care, which has blocked any progress on meeting these goals.  We offer a detailed program that will improve the quality, cost, and coverage of health care throughout the nation, and we will turn that plan into reality.

Very intrigued. You want further simplification of the system and you think the Democratic plan complicates it? Your – presumably very different – plan follows the "quality, affordable" tenets of the Democratic plan, but with less reliance on government? I want to know more!

"Patient Control and Portability": "Republicans believe all Americans should be able to obtain an affordable health care plan, including a health savings account, which meets their needs and the needs of their families." Well, here's the beginnings of it, but I still want to learn the details of this "health savings account" Where would the money come from, how does it differ from a regular savings account? "Families and health care providers are the key to real reform, not lawyers and bureaucrats. To empower families, we must make insurance more affordable and more secure, and give employees the option of owning coverage that is not tied to their job.  Patients should not have to worry about losing their insurance. Insurance companies should have to worry about losing patients' business." The substantive parts of all of that sound good, but they sound similar to the Democratic plan. Although I don't know how easy the Democrats make it to change health care providers.

"The current tax system discriminates against individuals who do not receive health care from their employers, gives more generous health tax benefits to upper income employees, and fails to provide every American with the ability to purchase an affordable health care plan." Democrats did call for employers to "have incentives to provide coverage to their workers", and all of these are fair points – and only the last, vague one mirrors the Democratic plan. "Republicans propose to correct inequities in the current tax code that drive up the number of uninsured and to level the playing field so that individuals who choose a health insurance plan in the individual market face no tax penalty." The Democrats did say that "[c]overage should be made affordable for all Americans with subsidies provided through tax credits and other means", but didn't directly address "inequities in the current tax code". "All Americans should receive the same tax benefit as those who are insured through work, whether through a tax credit or other means." Sounds fair, but I see no incompatibility with the Democratic plan.

"Individuals with pre-existing conditions must be protected; we will help these individuals by building on the experiences of innovative states rather than by creating a new unmanageable federal entitlement." Democrats wanted to bar insurers from barring people with "pre-existing conditions", so they wouldn't necessarily have to enter the "federal entitlement", but it does consist of more of that "regulation" Republicans hate so much. I want to know what these "innovative states" have come up with; the Democrats had a similar line there as well. "We strongly urge that managed care organizations use the practice patterns and medical treatment guidelines from the state in which the patient lives when making medical coverage decisions." Sounds somewhat obvious.

Then the Republicans start harping on semi-tangential "values" issues. "Because the family is our basic unit of society, we fully support parental rights to consent to medical treatment for their children including mental health treatment, drug treatment, alcohol treatment, and treatment involving pregnancy, contraceptives, and abortion." Some people might disagree, but this seems reasonable to me.

"Improving Quality of Care and Lowering Costs": And "help[ing] Americans – men, women, and children – live longer and healthier lives".

"Prevent Disease and End the 'Sick Care' System": Sound like Obama calling for "a health care system, not a disease care system"? "Chronic diseases – in many cases, preventable conditions – are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital." The Democrats cited a similar stat and vowed to "promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension." How would the Republicans "foster[] personal responsibility within a culture of wellness"? Why do I have a sinking feeling those "breakthrough medications" are a giveaway to pharmaceutical companies? If you need them great; ideally, you don't need them.

"To reduce the incidence of diabetes, cancer, heart disease, and stroke, we call for a national grassroots campaign against obesity, especially among children." The "party of small government" should know that a "grassroots campaign" started by government is a contradiction. "We call for continuation of efforts to decrease use of tobacco, especially among the young." I will never understand how people my age could possibly start smoking despite being bombarded all their lives by messages about how bad it is and considering how bad it stinks. We've been on an anti-tobacco crusade since, what, the 70s now? Do you think maybe we should start thinking about changing tactics, or at least adopting new ones?

"A culture of wellness needs to include the treatment of mental health conditions.  We believe all Americans should have access to affordable, quality health care, including individuals struggling with mental illness.  For this reason, we believe it is important that mental health care be treated equally with physical health care." These three sentences are almost redundant and give the impression that the Republicans are committed to mental health when they give no specifics.

"Empower Individuals to Make the Best Health Care Choices": "Clear information about health care empowers patients.  It lets consumers make better decisions about where to spend their health care dollars, thereby fostering competition and lowering costs.  Patients must have information to make sound decisions about their health care providers, hospitals, and insurance companies." Question is, will they even look at that information? I don't think I saw anything in the Democratic platform concerning this. This may be the most substantive part of the Republicans' alternate plan so far, but because many Americans get their coverage from their employer, it lacks a foundation.

"Use Health Information Technology to Save Lives":

Advances in medical technology are revolutionizing medicine. Information technology is key to early detection and treatment of chronic disease as well as fetal care and health care in rural areas – especially where our growing wireless communications network is available.  The simple step of modernizing recordkeeping will mean faster, more accurate treatment, fewer medical errors, and lower costs.  Closing the health care information gap can reduce both under-utilization (the diabetic who forgets to refill an insulin prescription) and over-utilization (the patient who endures repetitive tests because providers have not shared test results).

There's a germ of substantive policy in there. The Democrats did call for, more specifically, "driving adoption of state-of-the-art health information technology systems, [and] privacy-protected electronic medical records". All pretty common sense stuff.

"Protect Good Health Care Providers from Frivolous Lawsuits": It's Take-Shots-At-Trial-Lawyers Time!

Every patient must have access to legal remedies for malpractice, but meritless lawsuits drive up insurance rates to outrageous levels and ultimately drive up the number of uninsured.  Frivolous lawsuits also drive up the cost of health care as health care providers are forced to practice defensive medicine, such as ordering unnecessary tests.  Many leave their practices rather than deal with the current system. This emergency demands medical liability reform.

And that medical liability reform would be...? This is another thing the Dems don't touch on, and it's starting to form the germ of lowering the cost of health care, at least as described. But more is still to come.

"Reward Good Health Care Providers for Delivering Real Results":

Patients deserve access to health care providers they trust who will personalize and coordinate their care to ensure they receive the right treatment with the right health care provider at the right time.  Providers should be paid for keeping people well, not for the number of tests they run or procedures they perform.   The current cookie-cutter system of reimbursement needs restructuring from the view of the patient, not the accountant or Washington bureaucrat.

That certainly sounds reasonable – do you reimburse providers more for keeping costs down? Well, you don't say that. And what about what the Democrats call "insurance discrimination"? This sounds like a way of doubling that – one way to get "paid for keeping people well" is to keep out the people who aren't!

"Drive Costs Down with Interstate Competition":

A state-regulated national market for health insurance means more competition, more choice, and lower costs.  Families – as well as fraternal societies, churches and community groups, and small employers – should be able to purchase policies across state lines.  The best practices and lowest prices should be available in every state.  We call upon state legislators to carefully consider the cost of medical mandates, and we salute those Republican governors who are leading the way in demonstrating ways to provide affordable health care options.

Um... okay, this is an odd proposal. Does this mean that one or two states will be providing the health care for the entire nation? Wouldn't this render state-by-state policies meaningless? Why don't you just take away the state-by-state policies and pass the best ones on a national level? Don't you like the states?

"Modernize Long-Term Care Options for All":

The financial burdens and emotional challenges of ensuring adequate care for elderly family members affect every American, especially with today's aging population.  We must develop new ways to support individuals, not just institutions, so that older Americans can have a real choice whether to stay in their homes. This is true not only with regard to Medicaid, where we spend $100 billion annually on long-term care, but also for those who do not qualify for that assistance.

And those new ways would be...? I'm not even sure what you would look at here.

"Encourage Primary Care as a Specialty": "We believe in the importance of primary care specialties and supporting the physician's role in the evaluation and management of disease.  We also encourage practice in rural and underserved areas of America." No word on how, though. The Democrats provided more detail on how they would support primary care workers, but surprisingly, didn't mention the last sentence either in my Part I or in their "rural America" section.

"Funding Medical Research":

We support federal investment in basic and applied biomedical research.  This commitment will maintain America's global competitiveness, advance innovative science that can lead to medical breakthroughs, and turn the tide against diseases affecting millions of Americans – diseases that account for the majority of our health care costs. The United States leads in this research, as evidenced by our growing biotechnology industry, but foreign competition is increasing.  One way government can help preserve the promise of American innovation is to ensure that our intellectual property laws remain robust.

So, would big bad government actually directly fund this research? Certainly the Democrats talk about that. "[E]nsur[ing] that our intellectual property laws remain robust" certainly sounds good. The Democrats support research as a way of enhancing their health care plan, not so much as a way to fight diseases in and of itself. They accused the Republicans of stonewalling "biomedical and stem cell research", but the GOP mentions "biomedical research" here and doesn't mention anything that looks like a control (although I'm not done with the section yet).

"Federal research dollars should be spent as though lives are at stake – because, in fact, they are." I guess big bad government is getting into the spending business, but this certainly makes it sound like a worthy cause. "Research protocols must consider the special needs of formerly neglected groups if we are to make significant progress against breast and prostate cancer, diabetes, and other killers." What are these "formerly neglected groups"? Are they Democratic special interests? What are we talking about here?

Now come the political flashpoint issues.

Taxpayer-funded medical research must be based on sound science, with a focus on both prevention and treatment, and in accordance with the humane ethics of the Hippocratic Oath. In that regard, we call for a major expansion of support for the stem-cell research that now shows amazing promise and offers the greatest hope for scores of diseases – with adult stem cells, umbilical cord blood, and cells reprogrammed into pluripotent stem cells – without the destruction of embryonic human life.  We call for a ban on human cloning and for a ban on the creation of or experimentation on human embryos for research purposes.

"Whatchoo talkin' 'bout, Democrats? We love stem cell research! We just don't like embryonic stem cell research that destroys life." No permutation of the word "clone" appears in the Democratic platform, but I don't know enough about cloning to know where the controversy is, other than religious and philosophical questions. What's your position on "embryonic human life" that would be "destroyed" anyway? There are no mentions of assisted suicide in the Democratic platform either: "We believe medicines and treatments should be designed to prolong and enhance life, not destroy it.  Therefore, federal funds should not be used for drugs that cause the destruction of human life.  Furthermore, the Drug Enforcement Administration ban on use of controlled substances for physician-assisted suicide should be restored." What's your stance on people suffering from incurable terminal illness, other than brushing it off with "let's do more research so it becomes curable"?

"Protecting Rights of Conscience":

The health care profession can be both a profession and a calling.  No health care professional – doctor, nurse, or pharmacist – or organization should ever be required to perform, provide for, or refer for a health care service against their conscience for any reason.  This is especially true of the religious organizations which deliver a major portion of America's health care, a service rooted in the charity of faith communities.

What's this referring to, abortion? Since most of these services can be gotten elsewhere this seems reasonable, especially as a logical outgrowth of the First Amendment.

"Medicare":

Its projected growth is out of control and threatens to squeeze out other programs, while funding constraints lead to restricted access to treatment for many seniors.  There are solutions. Medicare can be a leader for the rest of our health care system by encouraging treatment of the whole patient. Specifically, we should compensate doctors who coordinate care, especially for those with multiple chronic conditions, and eliminate waste and inefficiency.

Most of the Democrats' talk about Medicare comes closer to the end of their platform, in a part I haven't gotten to yet. For now know that they want to "allow[] Medicare to negotiate for lower prices" which would be one way to cut costs. This proposal sounds reasonable and logical so far. "Medicare patients must have more control of their care and choice regarding their doctors, and the benefits of competition must be delivered to the patients themselves if Medicare is to provide quality health care." Sounds good, but don't know what to make of it and keep in mind we're talking about seniors. "And Medicare patients must be free to add their own funds, if they choose, to any government benefits, to be assured of unrationed care." That sounds reasonable as well, at first glance, but it means rich people would get better care than poor people. "Finally, because it is isolated from the free market forces that encourage innovation, competition, affordability, and expansion of options, Medicare is especially susceptible to fraud and abuse.  The program loses tens of billions of dollars annually in erroneous and fraudulent payments.  We are determined to root out the fraud and eliminate this assault on the taxpayer." Sounds good, but how do you plan to do that and what long-term structural reforms do you plan to institute without rendering Medicare at risk to economic downturns and changes in government? And didn't you just say "the benefits of competition must be delivered to the patients" and now you're calling Medicare "isolated from...free market forces"?

"Medicaid":

Our Medicaid obligations will consume $5 trillion over the next ten years.  Medicaid now accounts for 20-25 percent of state budgets and threatens to overwhelm state governments for the indefinite future.  We can do better while spending less.  A first step is to give Medicaid recipients more health care options.  Several states have allowed beneficiaries to buy regular health insurance with their Medicaid dollars.  This removes the Medicaid "stamp" from people's foreheads, provides beneficiaries with better access to doctors, and saves taxpayers' money.  We must ensure that taxpayer money is focused on caring for U.S. citizens and other individuals in our country legally.

The Democrats have even less to say about Medicaid; they mention extending it to more HIV-positive Americans and then don't mention it again until a section titled "Virgin Islands" virtually at the end of the entire platform! So presumably they're willing to let the Republicans' doomsday scenario happen. The idea of letting Medicaid beneficiaries buy whatever health insurance they want with their Medicaid dollars certainly sounds like a good idea. One more sentence of harping on illegal immigration at the end there.

"Building a Health Care System for Future Emergencies":

To protect the American people from the threats we face in the century ahead, we must develop and stockpile medicines and vaccines so we can deliver them where urgently needed.  Our health care infrastructure must have the surge capacity to handle large numbers of patients in times of crisis, whether it is a repeat of Hurricane Katrina, a flu pandemic, or a bioterror attack on multiple cities.  Republicans will ensure that this infrastructure, including the needed communications capacity, is closely integrated into our homeland security needs.

I seem to recall the Republicans may have mentioned this before, back in their national security discussion. This sounds like an important thing to do, to the extent you kind of wonder why we're not doing it already.

We're under 4,000 words, let alone 5,000, but the section on education started going so long it wasn't particularly plausible to stick it in this part without either threatening the 7,000 word barrier, or causing a contradiction by breaking in the middle of the education section for the GOP but not for the Democrats (with a firmer break with the latter to boot). So more Republican fun is still to come... and you may see two Democratic examinations before the next Republican examination.