ObamaCare: Broken Promises, Expensive Failures | The Threat of Rationing |
The Public Opposes the Law; It Should be Repealed | Targeted, Step-by-Step Solutions
to Solve Specific Problems
I believe in access to quality, affordable health care for every American that preserves individual choice and protects the doctor-patient relationship. To promote these objectives, I support legislation that would:
- Reform the tax code to enable more small businesses and self-employed individuals to provide coverage for themselves and their workers;
- Improve Health Savings Accounts and Flexible Spending Accounts, and make them accessible to more people;
- Reform medical liability laws to help reduce health-care costs; and
- Drive down the cost of health insurance by permitting the sale of insurance across state lines.
Broken Promise #1: “If you like your current health insurance, nothing changes.”
The President said it many times, but his promise turned out to be false. Medicare’s chief actuary recently testified that it is “not true in all cases” that people will be able to keep their coverage. Insurance carriers in at least 20 states, including Arizona, have stopped offering child-only policies since enactment of the law. The Medicare actuary estimates that implementation of ObamaCare will cut enrollment in Medicare Advantage by about half by 2017.
Broken Promise #2: “Nothing changes, except your costs will go down by as much as $2,500.”
President Obama said it, but, like the promise that people will be able to maintain the coverage they like, this promise will not be kept. The New York Times reported in March 2011 that “health insurance costs are still rising, particularly for small business.” The Wall Street Journal said that premiums are rising, with insurers citing the cause as the additional benefits they are required to provide under the new law.
Broken Promise #3: “This historic legislation will reduce the deficit by $143 billion over the next ten years, with $1.2 trillion in additional deficit reduction in the following 10 years.”
Then-Speaker of the House, Nancy Pelosi, said it and others joined her in touting the law as a way to reduce federal budget deficits, but the claim is based on budgetary sleight-of-hand. For example, to pay for the new long-term care insurance ObamaCare would provide, the law provides for the collection of 10 years’ worth of premiums to pay for only five years of benefits. Obviously, the long-term costs will drive the deficits higher, not lower. Even the Secretary of Health and Human Services labeled these provisions of the law “unsustainable.”
These and other gimmicks are why 200 economists – including former Congressional Budget Office (CBO) directors, Federal Reserve economists, and a Nobel laureate – wrote a letter to Congressional leaders calling for repeal of the health-care law. They suggest that it will significantly damage the economy due to the inclusion of more than $500 billion in tax increases at a time of high unemployment.
Perhaps the greatest risk that ObamaCare poses is that health care will be rationed. That is because the new health law lays the foundation for a system in which the government, not physicians and patients, would set the rules and make health-care decisions.
The stalking horse for this dangerous shift in policy is what is known as “comparative effectiveness research.” In the hands of doctors, medical researchers, and other health professionals, comparing the effectiveness of various treatments can help patients and their doctors make informed health-care decisions. However, in the hands of government, so-called comparative effectiveness research can become a tool to delay or deny care (and since private insurers tend to follow the federal government’s lead, this research has significant implications for all patients).
Such a system empowers government bureaucrats – not you, your family, or your doctor – to decide whether you get the care you need, based on an arbitrary cost-benefit analysis and the amount the government is willing to spend. In effect, the government puts a price tag, for example, on what an extra year of life is worth and then decides whether treatment is worth the cost. Government bureaucrats decide whether alleviating pain or saving a limb is worth the money.
Consider that the National Institute for Health and Clinical Effectiveness (NICE) in Britain uses “cost-effectiveness research” to make health-care decisions. NICE rejected a cutting-edge drug for use in treating bowel cancer because it said its limited effectiveness did not justify the cost. It rejected the same drug for the treatment of breast cancer, finding that the drug was “not a cost-effective use of NHS resources.” It rejected four new kidney cancer drugs, contending that the extra months of life for a few patients were not worth the cost of the drugs to the government. The examples are numerous.
The chairman of NICE summed it up this way: “If we spend a lot of money on a few patients, we have less money to spend on everyone else.” Obviously, such rationing of care is not something we should replicate in the United States.
Public opinion polls indicated that 61 percent of the American people wanted Congress to set aside health-care reform and focus on more immediate ways to improve the economy and create jobs. But the President and the majority in Congress ignored public opinion and approved ObamaCare anyway. The legislation was signed into law in 2010. (I voted against it.)
The day that it was signed into law, 13 states filed suit against it, and another 13 states have since joined the litigation. The state of Virginia filed its own suit on the day of enactment, bringing to 27 the number of states challenging the law’s constitutionality.
The central issue in these suits is the law’s “individual mandate,” which requires all Americans to buy government-approved health insurance whether they want it or not. If the individual mandate is upheld, the federal government’s power would be expanded far beyond what the Founding Fathers ever imagined. A federal district court judge who heard one of the cases in Florida put it this way: “If they decided that everyone needs to eat broccoli because broccoli is healthy, they could mandate that everybody has to buy a certain amount of broccoli each week.” Obviously, such an all-powerful government would threaten liberty as we know it.
Two courts have now struck down the individual mandate as unconstitutional, setting up a review of the law in the U.S. Supreme Court. Legislation is also pending in Congress to deal with the new law. I cosponsored legislation, for example, to impose a moratorium on any further implementation of ObamaCare until there has been a final resolution of the lawsuits.
The U.S. House of Representatives considered a bill to repeal the new law outright. House Members voted overwhelmingly for repeal – 245 to 189 – but with the President’s party still in control of the Senate, the full repeal bill failed when it was put to a vote in February 2011. (I voted aye.)
There will nevertheless be further attempts to repeal central pieces of the law, deny funding for its implementation, or change specific parts of the law. For example, the Senate voted 81 to 17 to repeal the so-called “1099 provision” that requires businesses to report every purchase of $600 or more to the Internal Revenue Service, creating a costly new burden on employers at a time when they should be devoting scarce resources to job creation. Going forward, I will focus on repealing ObamaCare’s $60 billion tax on insurance, its limitations on physician-owned hospitals, and the Independent Payment Advisory Board that the President set up to squeeze Medicare even more than the law already does.
Listed below are a set of proposals that can solve specific problems in our health-care system without upending it and without creating undue government interference in health-care decisions.
Drive Down Health Costs for Small Businesses and Individuals
There are more than 488,000 small businesses in Arizona that account for over 47 percent of private-sector jobs in the state. One of the most important things we can do is make it easier and more affordable for these businesses to provide health-care coverage for their employees. We can do that by providing them with the same tax incentives made available to larger businesses to purchase health insurance for their employees, and promote the use of high-deductible plans paired with Health Savings Accounts.
Strengthen HSAs and FSAs
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) should be improved in a number of ways to expand coverage and promote their use. For example, current law requires employees to forfeit any money left in their FSAs at the end of the year, and that provides an incentive for them to spend the money whether or not they need medical products or procedures. That, in turn, needlessly drives up costs. Workers ought to be able to accumulate savings from year to year for truly necessary medical care.
We should also allow people to make larger contributions to their FSAs, and let them use the money to pay health-insurance premiums.
Tort Reform
Medical liability reform should be a part of any reform effort. While malpractice suits serve a valuable purpose for those who have truly been wronged, malpractice law in its current form is too often abused by trial lawyers who flood courts with baseless suits.
Many lawsuits hinge, for example, on an attorney’s claim that a doctor should have ordered extra diagnostic testing and imaging, and that forces doctors to practice “defensive medicine,” for example, ordering tests that are not medically necessary, but that will help protect them in case of a lawsuit. A recent study of orthopedic surgeons found that nearly 35 percent of all the imaging ordered was for defensive purposes.
There is evidence that malpractice reform helps reduce some of this defensive medicine. For example, a study published in the American Journal of Emergency Medicine found that the rate of ER neurologic imaging was much lower in states with tort reform laws in place.
Arizona has enacted some malpractice reforms that have already been successful. For example, it heightened the evidentiary standard in malpractice suits so that plaintiffs now have to prove by “clear and convincing evidence” that a defendant was negligent.
Limits on non-economic damages have also proven successful in some states. Capping non-economic damages at the federal level can help limit health-care costs nationwide.
Allowing the Sale of Health Insurance Across State Lines
According to the Council for Affordable Health Insurance (CAHI), the number of state-mandated benefits grew to 2,156 in 2010, up from 2,133 the previous year. These mandates can drive up the cost of coverage for everyone who purchases health insurance in a state by requiring them to pay premiums for services that they may not need or want.
At least 10 states now allow some individuals to purchase policies that are subject to fewer mandates and are better tailored to the individuals’ needs and financial situation. These are good developments, but we should also consider allowing the sale of insurance across state lines so that Arizonans can find the coverage they need and can afford, whether it’s offered in Arizona, Kansas, or elsewhere. Allowing individuals to purchase only the insurance products they need will drive down premiums in the only manner that works: free-market competition.
