Before the Affordable Care Act became law, one of the fundamental problems with the debate over health care was that Democrats and Republicans couldn't agree on the nature of the problem to be solved. Dems saw a system in which too many Americans paid too much and received too little, while the GOP saw a system in which Americans' health coverage was too good and families enjoyed too many benefits.Several years later, that argument has returned with a vengeance. TPM had this eye-opening report yesterday.
A Republican congressman outlined the way he would like to see the health care system operate if Obamacare is repealed, as GOP lawmakers are promising. It is a brave new world in which parents would wait and think about it before bringing in their sick or injured kids for costly treatments.The example Rep. Bill Huizenga (R-MI) gave in an interview with MLive.com was from his own experience when he waited until the morning after to take his youngest son to the doctor with an injured arm, because he did not want to waste money on an expensive emergency room visit. The arm, it turned out, was broken.
The Republican congressman explained to the Michigan outlet that he and his wife thought about taking their son to the emergency room, but they decided instead to wait and gauge his injuries the next day, to see if the child's arm improved. (It didn't.) Huizenga sees this anecdote as a model for how the process should work on a more systemic level."If you don't have a cost difference, you'll make different decisions," the congressman said, adding that financial burdens should be shifted to consumers because the current system "continue[s] to squeeze providers."Huizenga went on to say, "Way too often, people pull out their insurance card and they say 'I don't know the difference or cost between an X-ray or an MRI or CT Scan.' I might make a little different decision if I did know [what] some of those costs were and those costs came back to me."This is not a new argument. Among Republicans, it's not even unusual. It is, however, kind of terrifying.I first started writing about this about seven years ago, right around the time former House Majority Leader Dick Armey (R-Texas) summarized the Republican position in just 17 words: "The largest empirical problem we have in health care today is too many people are too over-insured." Two Republican congressman had a Wall Street Journal op-ed around this time making the same case: "When was the last time you asked your doctor how much it would cost for a necessary test or procedure?"It wasn't a rhetorical question. For most of us, if we have an ailment, we see a doctor and follow his or her recommendations. If physicians recommend tests they consider medically worthwhile, we naturally agree, knowing insurers will cover most of the costs.And for Republicans, therein lies the problem. If the system shifted the cost burden away from insurers and employers and onto individuals and their families, the result would be amazing savings -- because consumers would seek and receive less health care.The GOP idea, in other words, is to create a medical environment in which Americans are acutely aware of costs, to the point that we turn down recommended treatments. Our kid may have a broken arm, but can we really afford an emergency-room visit? My doctor says I need a CT scan, but can I really afford such an exam? My friend has a lump and an unsettling family history, but can he really afford to have it removed and sent to pathology? His spouse was prescribed medication by her doctor, but does she really have to take it or can she save some money by going without?In the Republican model -- by GOP officials' own admission -- these are the kinds of questions Americans should be asking themselves. Having excellent health coverage, Republicans argue, is a problem in need of a resolution. As the aforementioned Rep. Bill Huizenga (R-Mich.) put it, "If you don't have a cost difference, you'll make different decisions."As Republicans move forward with repealing "Obamacare" and looking for some kind of alternative blueprint, keep this simple fact in mind: much of the GOP is convinced your insurance is too good, and they intend to help improve the system by making your coverage worse.