The Republican candidates' proposal for healthcare reform does not provide universal coverage and is far more radical than those offered by the Democrats. Unlike Senator Clinton and Senator Obama, who would create a new government agency or system to offer the insurance plans available to members of Congress for those individuals who are unable to get coverage through their employers, the Republicans instead propose to give individuals and families tax credits to buy insurance. They want individuals to have the ability to buy insurance from other states where they currently reside. They would remove the states ability to regulate insurance companies arguing that individuals from one state should be free to purchase another plan offered at another state if it is cheaper. Currently insurers have to abide by state law, so if one state requires insurers to provide certain benefits, the cost may be significantly higher than another state which does not have those requirements. It is hoped that with the tax credits and allowing competition of insurance plans from different states that health insurance will be more affordable. Republicans believe quite strongly in consumer driven healthcare.
By changing the tax code and asking individuals now to shop more for health insurance, rather than employers, in many ways is very different than how the majority of Americans get health insurance. Currently, large employers are working directly with insurers and doctors demanding that they deliver high quality healthcare so workers simply need to choose from available plans during open enrollment. They don't need to worry about tax credits or taking the time to research what health insurance plan is best for them. Frankly, research shows that Americans don't want the responsibility of researching health insurance plans because it is so confusing.
What they propose mirrors what occurred with employers regarding retirement plans. In the past companies provided employees a pension plan. When they became too expensive to administer, most shifted from providing pensions to 401k plans, where individuals were simply given money to invest. Since everyone plans to retire, one would have thought individuals with the new responsibility would have taken an active role and invested wisely. What research has shown is in fact that they often don't enroll in 401k plans, and if they do enroll they don't actively manage their money or don't know how to invest, so that now many can't retire. Companies are now changing their policies and requiring employees to opt-out if not interested and are investing the money in a mutual fund with a retirement target date on behalf of their employees.
I expect the same behavior to occur when it comes to health insurance. It would seem that individuals would take charge of their health because they have more "skin" in the game. They might change their behaviors of smoking, overeating, alcohol use, and adopting a sedentary lifestyle and replace it with a healthier one. Perhaps, but from the retirement savings example, I doubt it. If you don't mandate people to do something they won't. The stakes are far higher than that of retirement planning. At least you can always make more money if you are healthy. If you are sick, you can't necessarily buy yourself good health. Too many of us take our health for granted. It is so precious and precarious that even the most healthy and unassuming children, who haven't had the chance to abuse their bodies can get very ill from cancers and other illnesses.
My biggest difficulty accepting the Republican plan is that I think health insurance is not a luxury or an optional purchase but a necessary requirement for individuals to stay well and if one gets ill, it prevents someone from going bankrupt as he tries to get better. This plan doesn't seem focused on providing universal coverage even though the American Cancer Society estimates that 1 in 2 men and 1 in 3 women during their lifetimes will develop cancer, the second leading cause of death. Note this statistic does not include skin cancer, which is extremely common or the leading cause of death, heart disease. This means we all can expect a medical problem sometime during our lives. What isn't clear is when.
Time will tell if this is the right plan for our country.