Policy-ish

GOP 'Roadmap' Summons Past Health Debate Ideas

Before Sen. Scott Brown's surprise victory in Massachusetts reframed the health debate, Democrats labeled the GOP the "party of no ideas" and alleged they refused to participate in talks as a political calculation. Now, President Obama, the top Democrat, is wondering what's on their minds after all.

The health map is blurry. i i

hide captionIs there a way out of here?

(iStockphoto.com)
The health map is blurry.

Is there a way out of here?

(iStockphoto.com)

If Republicans do choose to participate in Obama's proposed Feb. 25 health forum — a big "If", given that GOP leaders have set loads of conditions—what can we expect to hear from the alleged Party of No? Ideas, yes. But surprises, probably not.

A quick look back on Republican health chatter does show a roster of ideas beyond just malpractice reform. Many were aired well before the current overhaul debate began. A recent proposal from Rep. Paul Ryan, R-Wis., the ranking member of the House Budget Committee, binds many of them in a neat compendium — two decades worth of ideas generated by Republican health wonks.

Ryan's tome, "A Roadmap For America's Future," proposes allowing insurers to sell policies across state lines, promoting health savings accounts, replacing tax advantages for employer-sponsored insurance with refundable tax credits for everyone, and more.

Check out his ideas here. The health care section kicks off on page 43. Some of the same ideas also appear in piecemeal legislation introduced last year, and in the GOP leadership's proposal.

If you've been following health policy for a while, these thoughts might sound familiar. Sen. John McCain, R-Ariz., suggested many of them during his 2008 presidential campaign. McCain's squad of GOP health thinkers helped formulate many of the concepts still in circulation during the preceding two decades. The team included, for instance, John Goodman, the so-called "father" of health savings accounts, and Harvard professor Regina Herzlinger, the "godmother of consumer driven health care."

Goodman, for his part, laid the groundwork for some of these ideas — especially HSAs and "equalizing tax advantages" now extended only to people who get insurance through their employer — in his 1994 book, Patient Power: The Free-Enterprise Alternative To Clinton's Health Plan.

Critics on the left will contend that if Republicans were serious about health care, they would have enacted some of these changes while they controlled Congress from 1995 until 2007, and that the market-based GOP proposals wouldn't synch up with Democrats' more government-focused plans.

But, some observers outside of the Republicans' corner see some fresh possibilities in the market-and-consumer-oriented approach favored by Republicans. For instance, David Goldhill, a business executive and self-described Democrat, argued in a widely-circulated article for The Atlantic last year that his father may not have died of a hospital-related infection if doctors had viewed the patient as their customer, rather than the government's impersonal Medicare program.

Weaver is a reporter for Kaiser Health News, a nonprofit news service.

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