The Consequences Of A Government Takeover of Healthcare

On concerns from constituents regarding health care reform:

Saturday I was in Austin at a community health center, along with Congressman Lloyd Doggett, who had previously had an experience with some constituents who were upset about the direction of the health care debate in Washington, DC. And I must say, rather than what I’ve seen publicized in some corners that some people have said that one side or the other is represented to the exclusion of the other side, I must say everybody who had an opinion seemed to be well represented at the event I attended in Austin. And we’ll continue to have other ways to reach out to constituents and both inform them but also listen to them and their concerns.


On problems associated with a Government Takeover of our health care system:

When it comes to things like the public plan or government option, that if you believe as I do the Lewin Group and other health care experts, would ultimately leave as many as 119 million Americans who currently have health coverage they like, would ultimately leave them with no option but a government plan. Obviously other parts of this are extraordinarily controversial, things like pay or play mandate for small businesses and other employers.

The other part of it is obviously access. And we know that we need to focus on the population that does not have good access to quality health care. By the way, we might also take note that even under current government programs like Medicaid, many low-income children don’t have access even though they have coverage because of low compensation rates and other impediments, they can’t actually find a doctor who will see them for what the government is willing to pay. So it’s not as if Medicare and Medicaid are perfect models for a new government health care plan. Neither one of them are fiscally sustainable and both of them have severe problems with waste, fraud and abuse and pay at such low rates that many physicians simply opt out, leaving patients with nowhere to turn.


On the High Costs of Democratic Proposals To Date:

I think many of the proposals we’ve heard in Washington today miss the point that most people like what they have. The problem is that cost is an issue. And virtually none of these proposals so far I think really address that point.

One of the early indications from the CBO was that the HELP Committee plan and the plan out of the House could cost in excess of $1 trillion. The problem is these are incomplete estimates because, as you know, most of the proposals call for full implementation to begin in 2013, not coincidentally after the next presidential election. If you look at a full 10 year budget window, according to the figures that have been compiled by Senator Judd Gregg’s Budget Committee staff, the full implementation of the House bill will cost $2.4 trillion over 10 years, and the HELP bill, the Health, Education, Labor and Pensions Committee bill, will cost $2.2 trillion.


On Health Care Reform from the Bottom Up, Not the Top Down:

If the point is most people have what they like and cost is the predominant issue, what can we do to bend the cost curve? What do we do to bring down the cost of health insurance? And I think on this point, there is a lot of consensus. I think we all believe that insurance markets should be reformed to increase competition and ensure those with pre-existing conditions get access to care. But the problem is, most of what we’re hearing out of Washington is a one-size-fits-all overhaul, and instead I think it would be more productive to talk about state-based solutions that reform health care from the bottom up, not from the top down.


On Importance of Medical Liability Reform:

One thing that is glaringly absent is serious talk about medical liability reform. In Texas, we’ve had tremendous success with reasonable medical liability reform, which has improved access to doctors because we’ve had a flood of new doctors moving to the state because of our predictable and more affordable medical liability insurance coverage. We all know that transparency on price and quality will better inform consumers of health care. We need to incentivize healthy behaviors, and we need to realign incentives when it comes to providers who are compensated based on value and not on volume, much like the Mayo Clinic model and others that are well known to you.


On the Government Plan’s Impact on Small Business Owners:

How do you pay for that? The last thing I would think you would want to do would be to undermine further those two unsustainable programs – Medicare and Medicaid – from a fiscal standpoint, but that’s exactly what some of the proposals are - to take $500 billion from Medicare to help pay for this new government program. And then of course, there’s the surtax proposals that have been made, which of course have been focused on the wealthy, but overlooking the fact that many small businesses are not incorporated or they’re Sub-Chapter S corporations. And many small business owners, the primary job creation engine in our economy, would be affected by these higher taxes, these surtaxes, which strikes me as exactly the wrong thing to do when you have a struggling economy and are in a recession.


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