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Critical Condition

NRO’s health-care blog.

Jindal’s Poll-Driven Health-Reform ‘Ideas’



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Yesterday’s Washington Post ran a column by Gov. Bobby Jindal (R., La.), in which he chastised “so-called Republican strategists” for conceding health care to the Democrats.  So far, so good: But this is not a new complaint. In the 1980s, John Sununu, as chief of staff to President Reagan, is reputed to have dismissed Prof. Alain Enthoven with a curt: “If the American people want health care, they’ll vote Democrat.”

Unfortunately, while some of Mr. Jindal’s proposals are good, his op-ed is clearly the work of a professional politician (and his staff): A cobbling together of “solutions” that the uninformed public rate highly when surveyed about health “reform.” As a result, the grab-bag of ten “ideas” collapses into incoherence.

Some are useful: portability, medical-malpractice reform, expanded Health Savings Accounts, and tax credits to allow people to buy health insurance of their own choice — not the government’s.

Others are unobjectionable, but nothing to get over-excited about: Voluntary purchasing pools for small businesses, electronic medical records, transparency of pricing and quality, rewarding healthy lifestyles, and allowing young people to continue coverage under their parents’ policies after they reach adulthood.  (Actually, I’m not aware of any law that prevents you demanding this from your employer.)

A professional politician, Governor Jindal is careful to avoid specifying who is responsible for enacting any of these reforms: Should the federal or state governments legislate medical-malpractice reform? Will health insurance be the property of the individual or his employer? If the latter, how will the law enable portability? [Hint: It can't be done. Been there, tried that, via the Health Insurance Portability & Accountability Act (HIPAA) of 1996.]

One of Governor Jindal’s ideas is massively popular — and utterly wrong-headed: Requiring health plans to cover pre-existing conditions. (80% of respondents in a recent poll favor this.) Most people already “enjoy” this “protection” (which actually just shifts costs, rather than reducing them), via HIPAA.

In effect, HIPAA already imposes a “soft” mandate by requiring an individual to maintain continuous coverage (without a break of more than 63 days). If he’s had prior coverage for at least 18 months, a new insurer cannot exclude a pre-existing condition. Mr. Jindal fails to explain why HIPAA has failed to reduce costs and increase access, but his proposed blanket prohibition on any exclusions for pre-existing conditions would succeed.

Indeed, Governor Jindal explicitly rejects the tax-hikes that would make a “hard” mandate enforceable, so perhaps he should explain how he will prevent health insurers going bankrupt, after everyone has the legal option of waiting until they get sick to buy health insurance.

— John R. Graham is director of Health Care Studies at the Pacific Research Institute. 



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