Health Care Reform and the GOP Platform

Party platforms are like cotton candy. They’re tasty and sticky (if a bit too sweet) for a brief moment of time and then they’re forgotten. Who can recall a lawmaker proclaiming their support for a measure because it was consistent with her party platform? Nonetheless, in a recent post I noted the Democratic Party platform’s rejection of a single-payer, government-run system.  Which got me thinking about what the Republican Party platform had to say about health care reform.

The answer is: nothing much different than what John McCain has been saying. Entitled “Health Care Reform: Putting Patients First.” the platform begins with a First Principle: Do No Harm. Here, the GOP explicitly states the party “will not replace the current system with the staggering inefficiency, maddening irrationality, and uncontrollable costs of a government monopoly.” No surprise there. It follows with a call for “patient control and portability.” Here’s where the paty calls for lowering the cost of coverage and calls for empowering employees “the option of owning coverage that is not tied to their job.” They call for eliminating the current difference in tax benefits between insureds who buy their coverage on their own or obtain it through an employer.

The rest of the platform is fairly straightforward calls for lowering costs through prevention, transparency, reducing frivolous malpractice lawsuits, leveraging technology, support of medical research and identifying best practices. These are fairly common proposals and unlikely to raise the hackles of many voters. There are, however, two controversial items.

Declaring the family as the basic unit of society, the Republican platform supports “parental rights to consent to medical treatment for their children including mental health treatment, drug treatment, alcohol treatment, and treatment involving pregnancy, contraceptives, and abortion.” I’m not sure what this means in practice. It doesn’t sound like it would prevent carriers from covering treatment for these services to minors, only that the parent could decide not to take advantage of them. Other than in life threatening situations I’m not aware of anyone forcing a parent to take their addicted child in for drug treatment. So it’s unclear to me whether this is simply a family-friendly statement or if it’s attacking a serious problem.

The second controversial item is a call to “Drive Costs Down With Interstate Competition.” This reflects a pillar of Senator John McCain’s health care reform plan. “A state-regulated national market for health insurance means more competition, more choice, and lower costs.  Families – as well as fraternal societies, churches and community groups, and small employers – should be able to purchase policies across state lines.” I’ve expressed surprise that this approach would find favor in the Republican party. Usually the GOP is in the forefront of allowing states to set their own rules. By allowing a health plan filed and approved in one state to be sold in every other state they undermine the ability of every state to create their own approach to health care coverage. This proposal would encourage jurisdiction shopping in which health plans would seek approval for their offerings in the states with the most lenient regulation and loosest rules.

The goal of encouraging competition is a good one. Even the idea of a national platform of health insurance rules has merit. In many respects, however, the GOP approach of “pick a state, any state” is the worst of all worlds. Moving regulation of health insurance products from the states to the federal government would provide uniformity (meaning products would meet minimum standards regardless of where they’re sold), but at the expense of accepting regulators that are more distant from consumers. The current patchwork of state regulation creates 51 silos that makes achieving best practices more difficult and lessens competition, but it keeps decision making closer to consumers. Allowing jurisdiction shopping neuters the ability of consumers to influence regulators while doing little to achieve uniformity in rules and offerings.

While the interstate competition provision is, in my opinion at least, a violation of the principle of “doing no harm,” the rest of the GOP platform is consistent with the no new taxes, keep government out of it philosophy that is at the foundation of Republican policy making. In that regard it’s not a surprising document. Given the insecurity many Americans feel about their continued access to health care, I am surprised that the Republican Platform doesn’t emphasize the desire to reduce the number of uninsured in the country. On the other hand, by elevating portability to the core of their proposal, they are seeking to reassure those now afraid to change — or lose — their jobs and thereby lose their health insurance.