Thank you, Bob Reich, for pointing this out:
Years ago, conservatives and their think tanks latched onto the individual mandate as the way to get health insurance to Americans. It was ideologically more acceptable than requiring all employers to provide coverage for their workers, and vastly more palatable than a single payer system. Tax credits, too, surfaced years ago, and gained some traction during the 2004 presidential race, when both John Kerry and George W. Bush embraced tax subsidies for families with lower incomes.
At the time, Michael Chernew, then a health policy expert at the University of Michigan and now at Harvard, told The Nation that “the evidence suggests that subsidizing insurance premiums will be a relatively expensive way to encourage coverage, and relatively few people would respond.” This year’s version is still expensive, but Congress addressed the second part of Chernew’s critique; the individual mandate with penalties will require people to respond.
High-deductible insurance is now an integral part of the American health care model. Policies sold in the small group market, for example, will carry deductibles of $4000 for families and $2000 for individuals. As in Massachusetts, policies sold in the Exchanges will also carry high deductibles. The conservative think tank National Center for Policy Analysis—along with Patrick Rooney, then CEO of Golden Rule Insurance, which is now part of the giant UnitedHealth Care—pushed Congress to allow high-deductible health plans. They are quickly moving into mainstream insurance acceptability.
A look at the history of the Massachusetts reform law, the model for national legislation, shows that the Commonwealth Health Insurance Connector—the state’s name for its shopping exchange—was born at the conservative Heritage Foundation. A document circulated by the staff of Gov. Mitt Romney at the time called for a law reflecting “a culture of insurance” and “personal responsibility”—the latter a keystone of conservative ideology.
The embrace of conservative ideas also helps explain why real cost containment didn’t make it into the final product. Curbs on prices are anathema to American business, and perhaps that’s why the president made a deal with the drug companies early on not to fight for negotiated prices in the Medicare program, a pledge he had made during his campaign.
All this explains why the usual right-wing think tanks weren’t especially vocal during the final stretches of the bill’s path to enactment. Their ideas were going to become law—which makes it all the more puzzling that the Republicans have fought so hard against the legislation. “The significance of Obama’s health legislation is more political than substantive,” Reich wrote in his TMP column. “For the first time since Ronald Reagan told America government is the problem, Obama’s health bill reasserts that government can provide a major solution”—albeit a solution that relies on the private market to deliver the goods. The question is whether health care is a commodity that the marketplace can manage with government help. Or will something else be needed in the distant future?
High-deductible plans are something the elites of both parties love to push. It fits their vision of “personal responsibility.” What it is, in plain language, is a financial disincentive to get needed health care.
This is mitigated somewhat by the fact that the law subsidizes out-of-pocket expenses, including co-pays and deductibles. But we still need to fight for the higher subsidies that were included in the original House version of the bill.