One Example Of Why We Can’t Take The Republicans Serously On Health Care

[youtube=http://www.youtube.com/watch?v=ZFH390hvKAI&feature=player_embedded]

Michael Steele, Chairman of the Republican National Committee, has been attacking the Democratic health care reform plans as a “reckless experiment” that’s “too much, too fast, too soon” but he doesn’t seem to know the fundamentals of what the debate is about. In the above clip (hat tip Talking Points Memo) Steele was asked if Republicans support an individual requirement. Steele responded by asking, “What do you mean by an individual requirement?” When this was explained to him he still dodged the question saying he doesn’t “do policy.” Apparently his role is to attack Democratic policy proposals without having any idea what they mean or having any alternative policy proposals to offer.

I’ve often derided Republicans for statements which lump together everything from increased government regulations of the insurance industry to outright government run health care as in the United Kingdom in their attacks. I’ve considered this a strategic decision to try to confuse the issue by lumping together quite different ideas. In some cases, such as with Steele, it might just be that they have no understanding of the issues. Either way it shows why it is pointless to pay attention to the Republican talking points on health care which have no relationship to the real issues being considered.

16 Comments

  1. 1
    Fritz says:

    Yeah — that’s pretty bad.  It’s time to do some policy, guys.

  2. 2
    Ron Chusid says:

    Especially on this issue. If they had a plausible plan without an individual mandate I might back them on it. Unfortunately the only plans on the table which remotely address the problems in health care include an individual mandate.

  3. 3
    Fritz says:

    Nobody is willing to go with “there is no individual mandate but if you have no plan and you have no cash then you die if you guess wrong”.  Which actually gives the most freedom to individuals.

  4. 4
    Ron Chusid says:

    An individual mandate is the simplest (ignoring matters such as freedom) and the insurance companies sure want it. There are precedents for having a government health program without mandates. Medicare B (which handles physician payment) and Medicare D (Bush’s drug program) are both voluntary. I would expect that any plan without a mandate carry pretty heavy incentives to join early as opposed to taking a free ride and joining later.

  5. 5
    Fritz says:

    BTW — I know the issue of including abortion in the plans is causing political fun.  What level of mental health therapy is included in the plans?  That could be a bottomless pit of political entertainment.
     
    And are they doing anything on dental?

  6. 6
    Ron Chusid says:

    Who knows for sure what the final bill will say, but a goal has been to have parity between physical health and mental health. Medicare pays less for mental health office calls compared to an equivalent office call for physical problems, leaving the patient responsible for the higher copay. There was a measure to give parity to mental health coverage passed last year but I believe it is being phased in over 6 years. There was also a measure to require more parity in group health plans which doesn’t take effect until 2010.

    I’m not certain of the specifics of payment for mental health services as I simply avoid billing for it. Any patient I see whose primary problem is depression also has a whole bunch of physical ailments which I can bill under.

    I doubt dental will be addressed in health reform legislation.

  7. 7
    Leslie Parsley says:

    I’m glad Fritz brought up parity for mental health care. This is an area that is treated like an ugly stepchild and no one wants to look it in the eye, much less confront it. People who can’t afford needed psychiatric care either don’t get treatment or they are thrust into a system where they get inadequate and inconsistent care. Even if  they have the insurance  and need hospitalization, the limitations on the amount of stay are so severe as to be laughable. Just ask the man on the street.

  8. 8
    Ron Chusid says:

    Higher out of pocket expenses limits access to psychiatric care for obvious reasons. On top of that, psychiatrists are unlikely to accept Medicare patients, further making it difficult for many people to receive psychiatric care.

  9. 9
    Fritz says:

    And psychologists get left out in the cold, even if talk therapy is more appropriate than drugs.

  10. 10
    Eclectic Radical says:

    “And psychologists get left out in the cold, even if talk therapy is more appropriate than drugs.”
     
    Well, in many circles, psychology is seen as an indulgement for the wealthy, which is kind of silly. However, the psychiatrists I have seen (on the two occasions I have seen one), had MSWs in their offices who did provide more basic counselling services when drug therapy was not needed or in addition to drug therapy. I have mostly been happy with the MSWs I’ve talked to… one was excellent, one reasonably good, and one so bad I stopped seeing him. Pretty much like anything else.
     
    I hate to sound like a corporate cheerleader for them again, but once again this is where Kaiser shines. They cover mental health on exactly the same scale as standard medical care and maintain their own psychiatrists, psychologists, and MSWs. If one doesn’t like one of the professionals in question, changing is not a hassle, they find you someone else or give you anyone on their payroll you ask for.
     
    Of course, if you’re a college student in Kansas and there is no Kaiser facility handy, getting them to pay can take a little work. But the clinic I attended was very willing to bill Kaiser and deal with the hassle.
     

  11. 11
    Ron Chusid says:

    Fritz,

    Medicare and many private plans do cover psychologists. I don’t know the specifics as I do not have any reason to bill for such services but I do find it is much easier to get Medicare patients into psychologists than psychiatrists.

    Besides parity for psychiatric services, the recent attempts to pay more for primary care services as compared to procedural services will also help psychiatrists. Paying more for their time (along with paying primary care physicians more for our time) will even increase the chances that a psychiatrist can afford to spend time on talk therapy.

  12. 12
    Fritz says:

    Cool.  The MSFT plan is really good there, but I don’t figure my experience there has much to do with most plans.
     
    Since psychological treatment is almost as contentious as abortion, I expect all sorts of lively politics.

  13. 13
    Ron Chusid says:

    I wouldn’t expect psychological treatment to be anywhere near as contentious as abortion. It is already covered by many plans, and other than perhaps a few scientists nobody would equate psychological treatment with murder as some conservatives equate abortion with “baby killing.”

    I’m glad to hear that Microsoft is good above covering psychological treatment for employees. I imagine that some employees must snap from time to time after seeing Windows act up.  🙂

  14. 14
    Fritz says:

    The local gun ranges do pretty well from that stress also.  🙂
     

  15. 15
    Leslie Parsley says:

    Many people with psychological problems – bipolar, ADHD, psychizophrenia among a few  – need both. A pschologist, preferably with a PhD, for talk therapy, and a psychiatrist, preferably one with a pharmaceutical degree as well, to administer meds and monitor their effectiveness. 

  16. 16
    Leslie Parsley says:

    Correction: should have said pharmacology degree rather than a pharmaceutical one.

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