Increasing tax breaks for health insurance will not materially increase the number of folks with insurance. Yes, there are several studies that purport the Bush plan will result in more folks buying coverage, but there are a number of studies that show it would result in a very small increase, or actually decrease the number of folks with insurance.
What is puzzling is the schizophrenia embodied in conservatives’ view on health insurance and taxation thereof. Bush, an avowed conservative, touts tax breaks as the way to get more people to buy coverage, an idea also central to the platform planks of Mssrs. McCain, Giuliani, and Romney (Huckabee’s ‘fair tax’ is, well, rather different).
Doesn’t this amount to a government subsidy of health insurance, one that will distort consumer behavior by reducing the cost of coverage, and therefore of health care? Bush et al try to address this via high deductibles, but isn’t that fixing a problem caused by their own tax policy? If conservatives have so much confidence in the consumer, why do they need to offer them a tax break to buy something that logically, it is in the consumer’s best interests to purchase?
Conservative policy types have suggested chopping the proverbial baby in two, by limiting tax breaks to those plans that provide a minimum level of benefits. The idea is to encourage coverage without subsidizing plans with excessive levels of benefits; those “Cadillac” plans. What parts of the plan make it a “cadillac”?
– Hospital coverage?
– Physician visit coverage?
– Drug coverage?
– Diagnostic test and imaging coverage?
– Behavioral and mental health coverage?
– Physical therapy?
Where’s the bling? Where’s the fine Corinthian leather, the Bose 29 speaker stereo, the gold-embossed hood ornament?
Where’s the ‘excessive’ insurance? If there is any, it is small potatoes.
I applaud the folks who are trying to square their philosophies with the realities of politics, economics, and health care. Their ability to tie themselves in knots in an effort to remain true to their ideology while fixing a problem is painful to watch.
I’m just now sure how that solution is ‘conservative’.

Single-payer advocates have won another skirmish in the battle over health care reform, while those in favor of reform based on the existing insurance marketplace (that would include your author) are once again trying to explain why big insurance companies screw up so badly so often.
An audit by the California Insurance Department and Department of Managed Health Care found that Pacificare routinely mishandled claims and customer inquiries, with ‘routinely’ defined as about one-third of the time.
For those (including me) forever excoriating health systems and hospitals for their outrageous error rates, the debacle at Pacificare, the recently-acquired division of United Healthcare (one of my past employers) make the delivery sector look like a paragon of performance. I’m not overly surprised, as mergers involve systems conversions, the amalgamation of provider networks and contracts, and the shifting of work around to different call centers and processing locations. Duplicate staff positions are identified and people laid off, and when they walk out the door so does the expertise and understanding that enabled the operation to run smoothly.
Some will argue that this is a temporary hiccup, that any merger of this type and size will inevitably result in problems. All true, as is the point that they could not be screwing up at a worse time – during an election year wherein the future of their business will be determined.
So far, the private sector is not making much of a case.
Thanks to California Healthline for the tip.

What does the Florida GOP primary say about voters’ views on health care?
At first blush, they aren’t concerned.

Continue reading Florida GOP results – implications for health care reform

My post on the GOP Presidential candidates and universal coverage elicited more than a few responses, most of which were cordial and helpful. Several took exception to the poll I cited (conducted by GOP pollster Tony Fabrizio’s firm) noting (accurately) that it was over six months old.
Fortunately, a comprehensive analysis of polling data re health care was just published. There’s a lot here, but the net is this – lots of Republicans support universal coverage. For example, in a NYTimes poll from late 2006, 44% of the Republicans polled favored “requiring…everyone have health insurance, with government helping to pay for insurance for those who cannot afford it.”
That is a lower percentage than the June poll; the difference could be in the wording of the questions or perhaps the population’s concern had grown over the eight months.
UPDATE – Another, very recent poll found similar support among Republicans for universal coverage – fully 65% would support reform that helped reduce the number of uninsured (23% favoring a plan to cover everyone, even if it would result in substantial additional spending and the remainder looking for a less ambitious plan that would likely only cover some of the currently uninsured)
The same poll found a slight majority of Republicans (53%) did not favor an individual mandate (a topic that is related to but not the same as universal coverage).
Comparing poll results can be touchy as the questions are usually different; Fabrizio’s June poll found 51% of Republicans agreed with the statement “Universal health care coverage SHOULD BE a guaranteed right of every American” (original emphasis).
And yet another poll, this one by the Commonwealth Fund, found a similar result – 52% of Republicans were strongly or somewhat in favor of requiring individuals to have health insurance coverage, with government help for those with limited incomes. (for independents the corresponding figure was 68%)
The Fabrizio poll is remarkably detailed and provides a breakdown of the perspectives of specific groups of Republicans. There are three segments that are most favorably disposed to universal coverage.
“Moralists” are the largest single group, accounting for 24% of all Republicans. Among the ‘moralists’, 48% were in favor of universal coverage. This segment is predominantly Born Again or Evangelical, poorer than the average, and disproportionately female.
13% of those polled were identified as “government knows best” Republicans (isn’t that an oxymoron?). The GKB folks were typically female and McCain fans, and fully 93% were supportive of universal coverage.
The third group, ‘Heartland’ Republicans (also 13%), were also McCain backers. Predominantly midwesterners, 72% supported universal coverage.
Digging ever deeper into the numbers, Republicans were more concerned with the cost of care (42%) than with covering everyone (19%). (Listening to Sen. Obama on health care makes me wonder if he carefully studied Fabrizio’s poll before coming out with the PR spin for his health reform plan; although Obama’s reform initiative is virtually identical to Sen. Clinton’s (except for mandated universal coverage), he has been consistently emphasizing cost control.)
While there are clear differences between the two camps, they do agree on one major issue: fewer than one in five voters, Republican or Democrat, believe it is the employer’s responsibility to ensure that people have health care.