A Challenge For The GOP

A perfect storm of healthcare crisis has descended on us.  Right in the midst of the Great

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Recession the baby boomers have begun to retire at the same time as the obesity epidemic blooms, portending an explosion of heart disease and diabetes.  In a perfect world this should cause all Americans to candidly re-examine the proper role of the government in healthcare and our own collective responsibility for the general welfare.  Instead there seems to be mainly anger at incumbent politicians for not providing what we all want for free.

Healthcare again?  Sorry, I know you don’t want to hear it, but it’s the 900 pound gorilla in the room and it isn’t going away.  In fact, it’s getting mad as hell.

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The media seem to be in agreement that the GOP is on the eve of sweeping election gains that will leave them in control of both houses of Congress and as we all know one of the first mandates of their Pledge to America is to rescind Obamacare.  This will present them an opportunity to be more than the party of “NO.”  Make that “obligation”, not “opportunity.”

Also, there are court challenges being brought against the program by 20 states for unconstitutionally forcing the 40% of potential but uninsured healthcare customers to pay into the system.  Given the right-slanted Supreme Court right now one has to think it would be receptive to junking it.

As I have posted before, Obamacare is not really insurance but a government mandate that all citizens share the cost of healthcare, including that for pre-existing conditions and major illnesses.  Although some call it socialism, IMHO President Obama deserves credit

for even daring to tackle this historically-intractable problem.   Obamacare would at least slowed the rush to the financial cliff.   If repeal happens, or if one of the state lawsuits is successful, won’t the GOP then have to propose to replace it with something? Given the rhetoric of the campaign, the president could hardly be blamed for accepting such a GOP plan as a mandate from the voters .

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At the center of the financial problem is a law that has been in effect since 1986:  the Emergency Medical Treatment and Active Labor Act (EMTALA).  It requires hospitals and ambulance services to provide care to everyone, regardless of ability to pay. According to the Centers for Medicare & Medicaid Services, 55% of U.S. emergency care now goes uncompensated.  When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated.  As a result hospitals have raised prices to absurd levels to try to recover as much as they can.  Many ER’s are shutting down and hospitals are struggling financially. The situation is unsustainable.

Congress won’t have long to act because things are getting worse quickly.  Financial pressures on hospitals in the 20 years since EMTALA’s passage have caused them to consolidate and close facilities, contributing to emergency room overcrowding.  According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the U.S. grew by 26 percent, while in the same period, the number of emergency departments declined by 425.   Ambulances are frequently diverted from overcrowded emergency departments to other hospitals that may be farther away. In 2003, ambulances were diverted over a half a million times.

Republicans have offered a variety of “solutions” to the problem, but none seem to me to come close to providing what is needed, which is, to use Anson Burlingame‘s recently-uttered phrase, to “make available” good healthcare for all Americans.  Easier said than done of course.

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What is missing of course is cost-feedback to the consumer.  Neither Obamacare nor any GOP plan I’ve seen comes close to solving the ballooning costs of medical care.  Interestingly, doctors have some ideas on how to cut healthcare costs, but none of them seems to know how to implement them.  Clearly, at least to me, government needs to step in and take ownership of the problem.  So here is my challenge to the GOP.   Congratulations in advance on your impending win in Congress. Now, what are you going to do to bring down healthcare costs, and what will you replace Obamacare with? Please hurry – we’ve been in the national ER way too long out here.  The emergency has arrived.

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About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Independent, tending progressive as the GOP recedes from its Eisenhower roots.
This entry was posted in Economics, Federal Government, Medicine. Bookmark the permalink.

11 Responses to A Challenge For The GOP

  1. Seems like you nail it here.

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    • Jim Wheeler says:

      Seemed that way to me too, Bruce, but you can see from Anson’s comments that he doesn’t agree. And “nailing” the description of the problem sure doesn’t solve it.

      It is a difficult and divisive issue, but IMO one of the most interesting because it challenges our system of government to solve it. Since WWII American society has been drifting farther and farther away from principles of self-reliance, and I know that is what bothers Anson and other conservatives. Our society is pampered, self-centered and entitlement-minded. It bothers me too, a lot. In the 50 million people without healthcare there are lots of selfish deadbeats, but there are also good, honest, hardworking people and single moms too, trying to raise the next generation by themselves. If government doesn’t take care of the latter at least, we make the problem even worse. That is the point i was trying to make about “batch” political decisions being different from “batch” military decisions affecting a cadre of mature, trained volunteers, but apparently I didn’t explain myself very well.

      Anyway, going back to the good old days is not politically realistic. To see human nature playing out just look at the violence in the streets of Paris lately, all because the government is poised to move the retirement age from 60 to 62! Similarly, some of the rhetoric around here lately: “My opponent wants to privatize/destroy/take away/water down your Social Security!” You can tell that resonates with the electorate and that is the political reality for any politician who wants to keep his job. (Bush I wanted to privatize it, but that was when the stock market was soaring. After the crash of ’08 it was obvious what a dumb idea it was, IMO.) Unless of course one political party, the GOP for instance, decides to really transform itself into the party of tough love and tell the electorate the truth. Might not work, but I would love to see them try.

      Jim

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  2. ansonburlingame says:

    Jim,

    You know quite well that my BIGGEST concern about Obamacare was its failure to even address much less resolve the cost of medical care. Republican input to address small parts of that problem such as tort reform and cross state insurance was simply outright rejected by Pelosi, et al. A solution, of course not, but a forward step, perhaps a small one, yes indeed in my view.

    We already had a 2700 page bill. Why not add those two elements to it with another 50 pages or so. Obviously the answer was pure politics, from trial lawyers to begin with.

    In two minutes on O’Reilly last night Krauthammer summed it all up. Obama wanted only to increase coverage for health care as his overriding concern. By adding another 30 Million to health care roles, requiring coverage of pre-existing conditions by private insurance companies and expanding coverage for older children cost of care, taken as a “bundle” HAD to go up. OK who HAS now to pay for it?

    Government, states and federal whom have NO extra money must pick up Medicade costs. Private insurance must pick up the expanded private coverage costs. The ONLY was to pay for THAT increase in coverage was to expand the mandate to purchase insurance, now under intense constitutional as well as public pressure.

    That provision in Obamacare to mandate purchasing insurance is a horse race to failure, either by courts OR by public mandate after Nov 2 through elected representatives.

    In my view the country CANNOT do as Obama has tried, expand coverage to all or most AND reduce costs. Neither Dems OR Reps can pull that rabbit out of the hat. So for now we have expanded coverage with cost be damned. Reps are going to, in all likely hood, reduce coverage back to 2008 or thereabouts, thus reduce some insurance and government costs, and let the devil decide what to do about the ???? uncovered.

    I HAVE heard loud claims by Republicans that they can and will fix the economy and unemployment. I have NEVER heard them say they can “fix” health care by simultaneously lowering costs and expanding coverage. NEVER has that been suggested by either party as a viable short term solution.

    But that is what you seem to be calling for, some knight on a white horse to provide social justice, pay for it and not bankrupt anyone in the process.

    IMPOSSIBLE in my view.

    Thus until government comes up with a solution, my choice is to further limit government, social justice of the type suggested above be damned, and let individuals sort it all out. Over time, THEY, not government will do so or at least have a much better chance of doing so.

    For 70 years we have been advancing the living hell out of social justice in America. If we keep on trying, you know what I suspect will befall us. Yep, the CLIFF, no matter how hard we try or how compassionate our intentions.

    How is that for a “good of the service” perspective?

    Anson

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  3. Jim Wheeler says:

    Well, Anson, as Reagan said, there you go again.

    My post HIGHLIGHTED the COST as the PROBLEM. And, the whole point of the post is that the WHOLE HEALTHCARE SYSTEM IS TEETERING ON THE BRINK OF COLLAPSE if there isn’t a fix. Now I don’t like the “cost be damned” Democrat approach for the same reason you don’t and I said as much. BUT, at least their’s is a STOPGAP measure. I have seen NOTHING from the GOP that even approaches a solution to the PROBLEM.

    And NO, I do not expect a rider on a white GOP horse to solve it. I expect the authors of the Pledge to America to step up to the bar with their new-found ASSERTIVENESS AS THE PARTY WITH THE ANSWERS and, with their new DOMINANCE of Congress, to tell the American people the TRUTH: THAT THERE IS NO FREE LUNCH AND IF THEY WANT HEALTHCARE FOR ALL AMERICANS IT WILL HAVE TO BE FINANCIALLY-RATIONED SOMEHOW.

    Now, let’s go to lower caps here. Cost being the problem, I (and God knows I do not profess to be an expert) see only two possible solutions.
    1. Modify or cancel EMTALA and put healthcare on a government-subsidized basis, along with counseling/advisory programs so that hospitals and doctors have to actually compete for business. This would lower costs and have the effect of cutting out unnecessary tests, among other cost-saving measures. The AMA would be aghast, of course.
    2. Socialized medicine – a complete government takeover.

    There are probably other options, which is why I did this post. So how about toning down the outrage and let’s get creative? 🙂

    Jim

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  4. Jim Wheeler says:

    Anson, one P.S.:

    You said, “Thus until government comes up with a solution, my choice is to further limit government, social justice of the type suggested above be damned, and let individuals sort it all out. Over time, THEY, not government will do so or at least have a much better chance of doing so.”

    In effect you are saying that the “poor” are, for now, on their own as far as you are concerned. Let them “sort it out” as best they can. Yet you say that government needs to make good healthcare available to all Americans. The two are incompatible.

    Actually, leaving everyone to “sort it out themselves” is pretty much the same as my idea (item 1. above), except for one little detail: in 2009 there were 50,700,000 Americans without any health insurance. Not to worry. They’ll sort it out. Hope they don’t need resuscitation while they do.

    Jim

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  5. ansonburlingame says:

    Well Jim,

    To begin with the number of uninsured was 40 Million the last I heard. Seems to be a moving target. I also heard that out of that 40 M, 10 M were illegal immigrants. Now we are down to 3o M. Out of that 17 M had sufficient income (over $50 K per year and up to $100K) to purchase health insurance, at LEAST of the catastrophic type, BUT those 17 M CHOSE not to purchase such.

    So now we are down to 13 M that earn less than $50 K per year (down to $0 per year) without health insurance, pre Obamacare and those folks were ALREADY elibile for Medicade. So what exactly is all the fuss?

    OK, argue with the above numbers. I certainly cannot verify them. BUT they came straight out of Charles Krauthammer’s mouth, a pretty smart guy that does not use hypeobola that I have seen.

    MY “dreams” or goal or whatever one calls it is indeed to find a way for health care, quality health care for all Americans. NO ONE knows how to do it yet and THAT is the problem. Coverage for all and reasonable and affordable costs are subsets of that PROBLEM. Dems have spend huge political capital to achieve Obamacare COVERAGE (which is STILL well short of the goal or dream) and have only caused costs to skyrocket (at least in terms of private insurance rates like the 47% in CT which is a DEM controlled state) and is going to bleed the states even more. Now remember the option discussed about a year ago at a Rep forum before the Globe about at least considering opting out of Medicare?

    You raise the issue of the Pledge by Republicans. I again point out that the Pledge says NOTHING about resolving healthcare other than to repeal Obamacare and sustain benefits for “senior, veterans and troops”. NO solution to the PROBLEM is proposed by Republicans, at least as I have defined the problem.

    I submit, without rancor, that Dems have not proposed a solution to that Problem as well, only a partial (OK, half-assed) solution that is further driving costs up for what was already the most costly item in the federal budget.

    Therefore, my analysis, thus far is NO ONE has a solution, particularly GOVERNMENT. So when government can’t do it, despite their best intentions, what is left to us as we have chosen to govern over the past 230+ years?

    Let the PEOPLE decide has ALWAYS, historically, been the approach. Well 70% of the PEOPLE, IF you believe polls, have now rejected the Dem partial solution. Thus my approach is to get federal government out of the health care business (except for government employees, including the armed forces) and let the people sort it out.

    Status quo before Obamacare seems to be what people now want, at least the majority. Such status quo does NOT SOLVE the problem as I stated it. But also using Krauthammer’s numbers, the problem is not nearly as BIG as Dems would lead us to believe. AND the status quo before Obamacare still had health care in emergency rooms for ALL. No one was left dying in the streets with no recourse other than death. SOME help was available “way back when”.

    Finally, let’s take a quick look at the Constitutional approach to health care. It says nothing as far as that being a federal responsibility. States can do whatever they choose however. For sure we can amend the Constitution to add health care as a federal responsibility. Now go try that approach and see what the PEOPLE have to say.

    Have we as a country ever seen things that were less than what we wanted? Sure we have. Now how many times has the federal government leapt into the breech to make things “right”, or maybe even just “better” and screwed it up unbelievably?

    Many, particularly of the liberal sort would call for the government, federal government to do “good”. And I don’t know how many times have I heard that doing “good” MUST be done NO MATTER WHAT IT COSTS.

    IMHO we MUST start ignoring that last all capital letter view and tell it like it really is for the costs involved. Then when we put realistic $Trillion price tags on things, look at potential income with or without tax increases to pay for that price it becomes a choice. A difficult and heart wrenching choice but still a choice.

    Then we can decide, democratically, what is the RIGHT choice even though it might well not be a GOOD choice, in this case for maybe 13 M out of 300+ M Americans.

    And ultimately this all comes down to personal choices at least at the polls. In terms of health care I see only two options being offered for now, Obamacare as written or repeal of such returning to 2008 health care status quo. So make your choice for now and vote Dem or Rep. Complaining about such lack of choice, particularly without a solution of ones own to at least propose, seems to me to be like taking a leak to the windward side of the bridge during a cold midwatch.

    For me MY choice (given the two options) is a return to the status quo 2008 and start again from there. The “progress” achieved thru Obamacare is merely a significant acceleration towards the even BIGGER problem that I see, which of course I call “the Cliff”.

    Anson

    Anson

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    • Jim Wheeler says:

      Anson,
      Please first, consider this statement from the Wiki EMTALA link in my original post. (Actually, all of it is worth reading.)

      Nevertheless, since non-citizens make up 21.2% of the uninsured, and they are the least likely of the uninsured to use emergencies rooms, their cost is at most $8.6 billion per year.

      For convenience, here is the EMTALA link again. The “Undocumented immigrant residents” part is about 2/3 down the page:

      http://en.wikipedia.org/wiki/EMTALA

      When you say we must abandon the notion of taking care of medical needs “no matter what it costs”, if you read my post and comments you will find that we agree. I said that the part of government that controls the purse strings, i.e., Congress, needs to tell the public the truth: the country can not afford runaway medical costs, nor can it afford for the insured under the old system, the one the GOP plans to return to, to pay for the uninsured. My frustration, as yours, is that there is no alternate plan.

      Now you say you don’t think the problem is as bad as I do. Perhaps the following link can be convincing that the old system is unsustainable, and that Congress must present some plan, even if painful.

      http://www.npr.org/blogs/health/2010/09/16/129908672/number-of-insured-americans-dropped-in-2009

      I believe that the most likely outcome of the November election will be the worst-possible one, a GOP house and a Democrat (or evenly-divided) Senate. If that happens, it is stalemate and we may see riots in the streets as the financial and healthcare systems fail together. But the point of my post is that, should the GOP win both houses, then I submit that the GOP then has an obligation to bite the bullet, like Great Britain seems to be doing, and submit a budget that makes sense, one that includes the healthcare problem. Because this rationale makes sense to me, and because I would like to hold the GOP to actually living up to its PLEDGE, and because I dread the idea of two more years of stalemate, I am currently leaning toward voting GOP, federal at least.

      Jim

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  6. ansonburlingame says:

    Jim,

    Given our political choices, usually dictated to a degree by “parties”, all of us must go to the polls holding our noses to some extent. It becomes the “best choices” we can make as individuals. Remember Plebe Year when each day we were confronted with terrible choices and had to decide to survive the next round “at the tables” or study to pass an exam. We wanted to do both but……

    And of course post November 2nd you left out above the BIGGEST factor, that being how the President will next decide to lead, follow or get out of the way. NO ONE knows how that is going to play out yet.

    As for the election, my prediction now is a House Rep majority of around 20 -30 seats (with a change of some 60-70 seats overall). In the Senate I see a 2-4 Dem majority remaining in power. That leads to your worst case scenario above and your fear of even greater statlemate with which I agree.

    The only way to break that stalemate is through Presidential leadership for the next two years. Based on previous exchanges discussing military and political leadership requirements I have great doubts that Obama can or will rise to the needed level of such leadership. You probably have greater confidence that he will do so.

    But I hope we both agree how vitally important such leadership for BOTH parties by the President is our only hope for progress in the next two years unless Rep gain a veto proof majority in Both houses of Congress.

    If that happens, please join me in Spiva Park while I lose my “dignity”.

    Anson

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    • Jim Wheeler says:

      Interesting simile, Anson, the plebe year choice. I remember it all too vividly. I thought I was hot stuff (academically) in high school. My class size was 160 and I ranked 16 (slow start Freshman year). At the end of plebe year at USNA we were down to, I think, 805 and I ranked about 802. There’s a “sea change” for you. (1st Class year standings taken alone, I was 252 of 800, so there’s your difference). Ah yes, those were the days.

      It occurred to me that despite all our commenting we still might have a different definition in mind when we say, “leadership.” If by that you mean a willingness to compromise, then I agree. As you now know, after the “Pledge to America” I feel the GOP has an obligation to compromise too and not just stick their heads in the sand. (I noticed you didn’t comment on the NPR link I sent you about the uninsured. Still not convinced of the magnitude of the problem?)

      Somebody has got to come up with a workable plan without pissing off both parties or we might be looking at President Christine O’Donnell after 2012! OMG.

      Jim

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  7. ansonburlingame says:

    Jim,

    Not sure about your last OMG. If “the witch” was President she would not lead herself to the bathroom. She would be in a “get out of the way mode” while riding her broom around the White House.

    My OMG, at least at this point without knowing what Obama will do 2011 and 12, is a SECOND tour for Obama!! And that is without concern for who might control Congress unless it was veto proof control.

    Anson

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  8. Pingback: Does President Obama's Healthcare Law Mean Hospitals Have To Treat Me?

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