To the very limited extent that the GOP is genuinely interested in health care reform, the rationale for it would run like this:
- High prices for health care in the US are driven by the fact that most payments are made by insurance companies, not the consumer.
- Therefore, the solution to the problem is to require the consumer to have more “skin in the game;” i.e., vastly higher deductibles and co-pays. That will deter wasteful spending and unwise lifestyle choices.
- However, we acknowledge that even salt-of-the-earth GOP voters can be unlucky with their health, and should be protected from financial ruin under those circumstances.
- Therefore, we should be moving towards a system of universal catastrophic health insurance. That would also protect hospitals and medical providers.
The Senate bill reflects this kind of thinking. Unlike the House bill, and like Obamacare, it ties subsidies to the ability to pay. However, the subsidies are deliberately designed to push everyone into a high deductible plan. These plans will leave virtually everyone with less coverage than they have today; that is a feature, not a bug, in the legislation.
The bill also eliminates the odious individual mandate, so it will be up to each individual American to decide if the coverage is worth it to him or not. CBO projects that most Americans will refuse to pay large sums of money for insurance that is useless to them under all but the most dire circumstances; the remedy for that is the emergency room, and refusing to pay. The GOP thinks catastrophic insurance has enough value that people will be flocking to purchase it even if they can’t use it on a day-to-day basis.
I think CBO is right. Furthermore, the GOP, by drafting the bill in secret, and by campaigning against high Obamacare deductibles, has done nothing to prepare the American people for this change in policy. Why on earth would anyone support getting skimpier coverage, and cutting taxes for the rich, without even hearing a policy argument for the proposition that too much insurance is a bad thing?
Realistically, there are only three ways to get to a universal catastrophic health care system: a beefed-up individual mandate; a single-payer system; or the elimination of the requirement that emergency rooms provide service regardless of ability to pay. The Senate bill features none of these. It cannot work.