The White House Health Care Summit has concluded. Unsurprisingly, Republicans continued to hit on tort reform as the way to lower our health care costs all afternoon. And they continued to be wrong. But a few more themes came up that are worth debunking.
First, Republicans kept insisting that if only average Americans had more "skin in the game" when it came to health care costs, those costs would go down. In particular, they tout health savings accounts as a solution.
In reality, health savings accounts are junk insurance, nothing but insurance company sponsored scams, good for the rich, like the Republican Members of Congress at the summit, but not for the rest of us:
Health savings accounts by definition favor the wealthy and/or the healthy. For those that never go to the doctor, or who can afford the high out-of-pocket costs incurred when using health savings accounts (you need to pay $1,050 as an individual or $2,100 for a family before your insurance will cover the rest), health savings accounts are great. Wealthy and/or healthy individuals can put a bit of money away, tax free, into their health savings account and then draw from it to pay their astronomical out-of-pocket costs when they decide to go see a doctor. If you're healthy, the doctor's visit doesn't happen very often. If you're wealthy, who cares if it happens very often, you can afford it.
For the rest of us, however, health savings accounts don't work. If we get sick and see the doctor often, we have to pay those huge costs often; that means we have to save a lot of money in that health savings account. For those on fixed incomes, or even those just barely scraping by (and that's a lot of us in today's economic climate), putting away even $4,000 in a health savings account is out of the question. Health savings accounts don't work for the same reason tax credits don't work: Those who don't have a lot of cash to save are forced to put away money they don't have a bit at a time to pay for their care. With tax credits, they get repaid at the end of the year. With health savings accounts, they don't pay taxes on that money. But either way, they need to save over the course of a year to get that payoff. For a lot of folks, this just isn't a realistic option - there's simply nothing to spare.
As the President pointed out, Republicans might feel differently about health savings accounts if they made $40,000 per year instead of the hundreds of thousands they make as Members of Congress.
Another perpetual Republican talking point was the wonders that would occur if only we could buy insurance across state lines.
In the Republican fantasy land, consumers would be able to buy cheaper or better insurance from another state. Here's what reality would look like:
Insurance is currently regulated by states. California, for instance, says all insurers have to cover treatments for lead poisoning, while other states let insurers decide whether to cover lead poisoning, and leaves lead poisoning coverage — or its absence — as a surprise for customers who find that they have lead poisoning. Here's a list (pdf) of which states mandate which treatments.
The result of this is that an Alabama plan can't be sold in, say, Oregon, because the Alabama plan doesn't conform to Oregon's regulations. A lot of liberals want that to change: It makes more sense, they say, for insurance to be regulated by the federal government. That way the product is standard across all the states.
Conservatives want the opposite: They want insurers to be able to cluster in one state, follow that state's regulations and sell the product to everyone in the country. In practice, that means we will have a single national insurance standard. But that standard will be decided by South Dakota. Or, if South Dakota doesn't give the insurers the freedom they want, it'll be decided by Wyoming. Or whoever.
This is exactly what happened in the credit card industry, which is regulated in accordance with conservative wishes. In 1980, Bill Janklow, the governor of South Dakota, made a deal with Citibank: If Citibank would move its credit card business to South Dakota, the governor would literally let Citibank write South Dakota's credit card regulations. You can read Janklow's recollections of the pact here.
Citibank wrote an absurdly pro-credit card law, the legislature passed it, and soon all the credit card companies were heading to South Dakota. And that's exactly what would happen with health-care insurance. The industry would put its money into buying the legislature of a small, conservative, economically depressed state. The deal would be simple: Let us write the regulations and we'll bring thousands of jobs and lots of tax dollars to you. Someone will take it. The result will be an uncommonly tiny legislature in an uncommonly small state that answers to an uncommonly conservative electorate that will decide what insurance will look like for the rest of the nation.
It's a race to the bottom, selling our health to the lowest insurance company bidder. It's not a solution that makes us more healthy or lowers our cost - CBO said selling insurance across state lines wouldn't expand coverage at all and would only save $12 billion over 10 years, a fraction of what real health care reform would save.
Finally, Republicans continually made the point that the American public doesn't want health reform. As Nancy Pelosi said, there have been so many lies about the health care bills, it's a wonder anyone likes them. And it's important to stand up for popular things - like a public option - to make it better. But that doesn't mean the American people don't want reform.
The latest Kaiser Health Tracking Poll is only the latest in a series showing the elements of health reform are popular:
Other parts of reform are really popular too, like the public option.
And majorities want comprehensive health reform passed:
And even more will be disappointed or angry if reform doesn't pass:
The Republicans didn't bring a plan to the summit today. Instead, they brought stale, easily-debunked talking points. They tried to prove that giving good health care to Americans was a bad idea, but they failed. And in the end, they resorted to the same slogans they've been repeating for a year now - start over, blank slate, incremental reform.
We've heard from the other side and found they have no plan to solve the greatest problem facing the nation. Now it's time to finish the job and finish it right.