Health Care For America Now

Yesterday, The Hill published an op-ed from R. Bruce Josten, executive vice president of government affairs for the U.S. Chamber of Commerce. In it, Josten declares that the status quo is unacceptable we have "an opportunity to start over and get things right" on health care. And yet what are his ideas to get things right? Killing health care reform and thus giving the insurance companies the thing they most want - a continuation of the status quo.

Before we dive into Josten's ideas, we should take a moment to consider the source. When it comes to health care, the U.S. Chamber of Commerce is nothing more than a front group for the insurance industry. Over the last six months, insurance companies have funneled between $10 and $20 million to the Chamber to run misleading ads trying to kill health care reform. This arrangement allowed the Chamber to carry the insurance industry's water and reinforce Republican obstructionism with millions in corporate cash while allowing the insurance companies to claim they were on the side of reform.

Given that the insurance companies have given Josten's front group tens of millions of dollars to oppose reform, it shouldn't come as any surprise that Josten's ideas for "getting healthcare right," if they do anything at all, are nothing but ways to extend the status quo, and as such are gifts to the insurance industry.

Josten's first idea, under the headline of "[controlling] spiraling healthcare costs" is that old Republican standby - tort reform. The nonpartisan CBO has already looked into this particular idea. They found medical malpractice costs account for only 2% of American health care spending and said that even “significant reductions” would do little to curb health-care expenses. Numerous health care studies and experts back up this conclusion. And experiences in states that have already capped damages show that tort reform does nothing to rein in costs. Texas is a prime example:

Contrary to Perry’s claims, a recent analysis by Atul Gawande in the New Yorker found that while Texas tort reforms led to a cap on pain-and-suffering awards at two hundred and fifty thousand dollars, which led to a dramatic decline in lawsuits, McAllen, Texas is one of the most expensive health care markets in the country. In 2006, “Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average — although the average town resident earns only $12,000 a year. “Medicare spends three thousand dollars more per person here than the average person earns.”

Tort reform doesn't control health care costs. It's that simple. Next?

Josten goes on to list a few ideas that are already part of the health care bill to control costs, things like "paying doctors based on quality, widespread adoption of health information technology, and allowing small businesses and individuals to pool their risk and deduct the costs of their insurance."

Josten next says he wants to fix the insurance market:

Insurers should be prohibited from denying coverage based on pre-existing conditions, turning people away, or charging vastly different rates for the same policies. However, for insurance reforms to work effectively it requires a fully insured marketplace and must be paired with a personal responsibility for all Americans to get health insurance.

I agree. For insurance markets to be fixed, everyone must be covered. But you can't cover everyone unless you make health care affordable, and you can't make health care affordable unless you provide subsidies for people so they can afford insurance. That's what the health care bill in Congress does.

Finally, Josten endorses a main part of health care reform:

Create real choice and competition through a health insurance exchange. Consumers should be able to easily compare insurance options in a way that is easy to understand, and any person or business should have access to a greater range of plans.

That's right. Real choice and competition would indeed be a good thing, especially forcing insurers to compete with a public health insurance option. That's all part of the House bill.

The only new idea Josten is proposing in this op-ed is tort reform, which won't do anything to control costs. Every other idea is already in the bill. Why, then, does the Chamber still oppose it?

Josten says the "job-killing tax increases, burdensome new employer mandates, significant cuts to Medicare, and a government-run insurance plan" are their reasons for opposition. As Jon Cohn explains, the Medicare cuts in the bill cut out waste in the system and leave the health benefits of seniors as they are:

Don’t the Democratic reform plans also take money out of Medicare? They sure do. But there are several key differences. For starters, the Democrats’ reductions don't appear to be as large as what’s envisioned in the Roadmap. Also, under the Democratic plan, most seniors would still be getting their coverage directly from the government, which has lower overhead than private sector insurers. So every dollar the Democrats spend on seniors would actually go a little further.

No less important, the Democratic plans wouldn't simply slash spending and let the market sort itself out. Instead, the Medicare cuts are part of a broader package of reforms designed to change the way Medicare pays for services. These reforms are designed to reward efficiency (by, for example, paying more to doctors that join integrated group practices) while penalizing inefficiency (by, for example, paying less to hospitals with high rates of infection or, eventually, paying less money for drugs that don’t work that well). They are also designed, quite frankly, to push down the prices that providers charge.

In fact, one of the key ideas Josten endorses - paying providers for quality, not quantity - is one of the main reasons Medicare costs can be reduced under the health care reform bill on the table.

As for the "job-killing tax increases," I'm not sure what Josten is talking about. The so-called excise tax is a bad idea, but it's not a tax that kills jobs. And "burdensome new employer mandates" Josten rails against? Just a simple requirement for businesses to provide good health care to their employees, coupled with generous tax credits to small business so they can afford it. The requirement that employers pay for health care is just like a minimum wage, another law that the Chamber of Commerce fought as "job killing." In fact, any time that employers are required by law to provide decent jobs by paying a basic wage, paying for health coverage, allowing workers to organize, the Chamber of Commerce leads the opposition.

In his opening, Josten claims people have it wrong about the Chamber:

Congressional leaders have presented the American people with a false choice when it comes to healthcare reform. They claim that opposition to their flawed bills is equivalent to opposing reform altogether. I couldn’t disagree more.

In fact, people have it exactly right. Josten presents no new ideas that would actually solve our health care crisis. He endorses many (if not most) of the ideas already in the health care reform bills. And yet, he still opposes their passage. If that's not an argument for the status quo, I don't know what is.

And that's exactly what Josten's insurance company paymasters want. They've known all along, as explained in this analysis done by Goldman Sachs for the insurance industry, that the status quo is the best scenario for the industry. That way, they'll get to keep their profits, their extravagant CEO pay, and their business practices that deny care to paying customers. This op-ed, appearing reasonable while offering no real ideas and yet opposing reform for ideological reasons, is exactly what the insurance industry paid tens of millions for.

The insurance industry wants nothing more than to maintain the status quo, and if Congress listens to Josten and the Chamber, that's what they'll get.