By Steven Pearlstein
Friday, February 26, 2010; A17
I'm not sure what else was accomplished at Thursday's Blair House summit, but surely one result is that we learned what Republican "leaders" really think about health care and health insurance.
The most important thing Republicans think is that if there are Americans who can't afford the insurance policies that private insurers are willing to offer, then that's their problem -- there's nothing the government or the rest of us should do about it.
"We just can't afford this," said Eric Cantor, the fresh-faced House minority whip from Virginia, while John Boehner, the House Republican leader, called it "a new entitlement program that will bankrupt our country." What they were referring to, of course, was the $125 billion a year that Obama and his Democratic allies propose to spend in subsidies so tens of millions of low-income households can afford to buy health insurance and handle the co-payments. But if paying for those subsidies means raising taxes on high-income households with lots of investment profits, or capping a tax break for people with extravagant health insurance, or charging a modest fee on medical device makers that refuse to moderate future price increases, then Republicans are agin' it.
That was their clear message Thursday. It was their message during all those years when their party controlled Congress and the White House and they did nothing and said nothing about the plight of the uninsured. And it is clear that they would continue to do nothing if, by some miracle, Democrats were to drop their plan or embark on a more modest approach. For Republicans, the uninsured remain invisible Americans, out of sight and out of mind.
Judging from Thursday's discussion, Republicans have much more sympathy for those who can afford to buy health insurance but are denied because of a preexisting medical condition. They oppose Democratic efforts to end this industry practice directly through regulation, preferring instead to refer those customers to special high-risk insurance pools where they would be guaranteed to find coverage.
In some versions of the high-risk pool, the cost of a policy would be so high that households with average incomes would have to set aside a third or even half of their income to pay for it. It takes a Republican to view this as a solution -- the equivalent of giving a starving man a coupon for $2 off his next dinner at Le Bernardin.
Or perhaps Republicans imagine high-risk pools that are subsidized sufficiently enough that the insurance policies are actually affordable. Unfortunately, the only way to finance such subsidies is through some sort of tax or fee, mostly one imposed on every insurance policy sold outside the high-risk pool. It's a fine idea but one that turns out to be the actuarial equivalent of what Democrats proposed in requiring that insurers charge pretty much the same premiums for everyone, with only modest variations based on age and health condition.
Another of the Republican "big ideas" was to make it possible for small businesses to collectively negotiate with insurance companies for better deals on health plans. But that's what Democrats have in mind with insurance exchanges that will do exactly that, not only for small businesses but also for the self-employed and workers at companies that don't offer health coverage. Although they never quite came out and said it, what apparently bothers Republicans about these insurance exchanges is that they would be overseen by governments -- the same state and federal governments that for decades have negotiated a wide selection of competitively priced plans for tens of millions of satisfied government workers, including members of Congress.
Then there's the issue of what minimal level of benefits a basic health insurance package should offer. Republicans, of course, used Thursday's forum to denounce the idea that such decisions should be made by Washington bureaucrats and politicians. But as my Washington Post colleague Ezra Klein points out, Republicans apparently would have no problem if those standards were to be set by bureaucrats and politicians in Nebraska, or North Dakota or whatever Republican state decided to offer itself up as the regulatory haven from which insurers could sell their policies nationwide.
To give them their due, Republicans did manage to raise some serious issues and make a few constructive suggestions in between their carefully choreographed talking points.
Sen. Jon Kyl of Arizona, among others, complained that the minimum standards set in the House and Senate bill weren't very minimal at all, but in fact exceeded the actuarial value of the average policy now sold in the individual and small-group markets -- and are certainly more generous than the high-deductible policies that have shown some success in restraining the annual growth in premiums. Why not, he asked, start with a more modest benefits package?
Rep. Dave Camp of Michigan raised legitimate concerns about the way malpractice suits and excessive damage awards can cause physicians to practice defensive medicine, needlessly driving up the cost of health care.
Sen. Tom Coburn of Oklahoma suggested using undercover agents to weed out the waste and fraud that he claimed were responsible for the fact that one of every three dollars in the Medicare and Medicaid programs is misspent.
And Sen. John McCain demanded that his former presidential rival renounce the special Medicaid funding formulas for Florida and Louisiana that were used to buy the support of those states' wavering senators.
What we didn't hear from Kyl, or Camp, or Coburn or McCain, however, was an offer to vote for a health reform plan if these problems were fixed and their ideas were incorporated. Without even the hint of such offers, there was little reason for a willing president and his unwilling allies to even consider serious compromise. Now the losers will be the American people, who could have surely benefited from such productive dealmaking.