Debate Prep for Thursday W/College Dems (Healthcare)
So this Thursday we (College Republicans) will be debating the Democrats. There are four topics: healthcare, women's health, humanitarian intervention, and immigration. I'll probably be doing healthcare and immigration. The prompt:
Do you support the Affordable Care Act in it's entirety? If not, why? Would you like to see certain provisions kept and how would this affect the successful implementation of the law? What alternative do you offer that would effectively lower health care costs and provide insurance for the currently uninsured?
What are some good sources of info for debate prep that can help me formulate a few points for argument? Right now I'm thinking that I'll reject Obamacare as a whole and propose market-based reforms: eliminate tax advantage for employer-provided plans; competition across state lines; premium support for Medicare/Medicaid. That's a start but I'd appreciate your suggestions.
Answer by John Murdoch
First, tort reform. America's legal system allows for contingent-fee lawsuits--the lawyer only collects a fee if he wins. The trial lawyers argue that this practice permits low-income people to use the courts to address their grievances. That's true.
But the overwhelming use of the system is to extract settlements--essentially a payoff from an insurance company to avoid the cost of going to trial. (Paying $10,000 to a plaintiff is dramatically cheaper than even a week-long trial.)
Most countries use a different system, called "loser pays." The poor still get access to the courts--but the respondent to a suit has a much more powerful incentive to take a case to trial. Tort reform in several states (for example, Texas) have dramatically reduced malpractice premiums. The absence of tort reform in other states (specifically, Pennsylvania) has led large numbers of doctors to leave the state.
More information from the Institute for Legal Reform.
Second, Health Savings Accounts.
HSAs combine a high-deductible health insurance plan (typically a $3,500 or $5,000 annual deductible) with an investment account. The insurance plan covers major expenses--hospital stays, etc. The investment account covers routine medical care.
Key point: money that is paid into the investment account is paid with pre-tax dollars; and any money left in that account is yours to keep.
This has the effect of restoring the personal incentive to health care--people pay careful attention to their costs, and actively look for ways to lower their costs. They challenge the doctor who is practicing defensive medicine--they challenge the doctor who is pushing an expensive drug when a lower-cost generic may be just as effective.
A terrific description of this, written about the state of Indiana's experience with HSAs, was written by Governor Mitch Daniels for an op-ed in the Wall Street Journal.
Third: do you support scrapping the entire ACA? When this comes up, turn to your opponent and say, coolly, "I agree with Harry Reid, Nancy Pelosi, and the Obama White House that if any part of the act is found unconstitutional, the entire act must be struck down."
It is common practice for legislation (and contracts) to include a "severability" clause. That clause provides that if any part of the law (or contract) is struck down by a court, the remainder of the law (or contract) continues in force.
The ACA had a severability clause in it through most of the time when Congress was deliberating--but the severability clause was removed. Deliberately, consciously removed by the House and Senate leadership--precisely because there were fears that parts of the act would be struck down, and the remainder would become unworkable. Congress's clear intent, made plain by the Congressional Record, is that Congress intended that if any part of the Act goes down, the whole thing does.
"Who am I," you coyly ask, "to second-guess Nancy Pelosi?"
Answer by Tom Lindholtz
Bereket, you write, "I'm thinking that I'll ... propose market-based reforms: eliminate tax advantage for employer-provided plans; competition across state lines; premium support for Medicare/Medicaid." John's comments above are excellent. Here are a couple further thoughts...
No need, necessarily, to eliminate tax advantage for employer-provided plans, just extend the tax benefit to self-provided plans. The source of the insurance -- employer vs. self -- isn't the problem. (A true, free-market approach where employers pay their employees a full check and employees pay for health insurance the same way they pay for car or home insurance is probably preferable, but that's a different argument.)
Competition across state lines for insurance could be a big help. Ironically, that is an area where, if you're going to have a broad Commerce Clause at all, this is where it makes sense. Preventing the individual states from erecting artificial regulatory barriers to the free flow of insurance intermediation would increase the competitive forces.
It won't win a lot of friends in the Senior Lobby, but I would suggest a planned move away from government support of Medicare/Medicaid premiums. It should come as no surprise to anyone that the normal course of life includes health issues that increase in complexity and expense as we age. This is something that the "prudent man" should be planning for and providing for. The simple fact is that our nation needs, for purely financial reasons, to move away from an entitlement orientation and to move toward a personal responsibility orientation.