The ballyhooed “health care” plan by Colorado Gov. John Hickenlooper, Ohio Gov. John Kasich and six of their colleagues arrived Thursday with a thud.
We applaud them for trying, but in seven pages written to House and Senate leadership, the governors pitched another minor tweaking of insurance. It is like they took the Affordable Care Act and the recent House and Senate proposals and blended them with a handful of related ideas.
The governors barely touched on health care and the potential for government to help ignite a more robust market of doctors, nurses, psychologists, clinics and hospitals to provide more care for more people at a lower cost.
After more than 40 references to “insurance” and “coverage” in the first five pages, the governors conceded that “coverage” isn’t the issue.
“Coverage is important, and coverage reforms can help contain costs, but eventually our nation needs to confront the underlying market dynamics that are driving unsustainable increases in the cost of care,” the letter states.
“Eventually.” Why not now?
We hoped the governors would pitch ideas for state and federal governments to help solve the root problem they identified. We expected talk of deregulation, to boost the supply of health care providers within each market. We hoped for talk of block grants to establish wellness clinics in neighborhood fire stations and federal grants to produce more medical students, health care entrepreneurs and clinics in strip malls.
Instead, the topic of “market dynamics” returned immediately to insurance tweaks. It is a rut the political class cannot escape.
“With the support of the federal government, states are resetting the basic rules of health care competition to pay providers based on the quality, not the quantity of care they give patients,” the letter explained. “This is true in our states, where we are increasing access to comprehensive primary care and reducing the incentive to overuse unnecessary services within high cost episodes of care.”
Got that? The governors believe we can resolve market problems, the underlying cause of the health care crisis, by having government insurance pay providers based on “quality” while driving people to primary physicians rather than emergency rooms. They gave congressional leaders no examples of how states are “increasing access” to primary care.
These are not big-picture ideas. They have nothing to do with growing the provider side of the health care market, which is the only way to increase access and lower costs in a country with a growing population of patients and a dwindling supply of physicians.
We have all heard the anti-Obamacare mantra that “coverage is not care.” Health insurance is currency. Like the dollar, the value of any insurance certificate relates directly to the availability of goods and services one can exchange it for.
Insurance reforms have a role, but they produce nothing. It is like printing and distributing currency and confusing it with economic growth.
The devaluation of our inflated insurance market collides with stagnation in the growth of health care and a worsening shortage of physicians. The declining value of insurance presents itself as high deductibles and co-pays few can afford. Insurance with a $10,000 deductible is of little value to the average consumer. Quite simply, inflated insurance policies buy less care.
Insurance has become so worthless the governors would force consumers to buy it, just to sustain the industry.
“Congress should leave the individual mandate in place until it can devise a credible replacement,” the governors wrote. “The current mandate is unpopular, but for the time being it is perhaps the most important incentive for healthy people to enroll in coverage.”
This is a blueprint for Obamacare 4.0, on the heels of the failed House and Senate plans of 2017. It is a plan to save insurance companies – not health care consumers.
We had high hopes for Hickenlooper, Kasich and their colleagues to propose a comprehensive state-and-federal vision for health care reform.
The country needs plans for more access, more competition and lower prices. Instead, we got another boring idea to slightly alter a regulatory scheme of insurance plans that will continue losing value. Thanks, but no thanks. We have Congress for small ideas like this.