Critical Condition

The Power of Small Ideas

The New York Times ran only one editorial in the Sunday paper this week, called “Small Ideas Won’t Fix It.” The point of the piece was to say that Republican ideas on health care are insufficient to address our health-care problems. As two people who have been hawking an alternative health-care approach called the “small bill,” we are happy to note that four of the ideas that the Times looks at are explicitly part of the plan — medical-malpractice reform, purchasing insurance across state lines, the expansion of health savings accounts and increasing reliance on high-risk pools. The Times claims that the ideas it reviewed “would barely make a dent in the most critical problems threatening the health care system,” but the truth is that the small-bill approach will go a long way towards making health insurance more affordable, accessible, and portable, at a fraction of the cost of either the House or Senate-passed Democratic alternatives. The Senate bill, for example, would spend about $2.5 trillion in its first ten years of providing subsidies — the period from 2014–2023 — and would actually increase the cost of insurance premiums. The small bill would cost $180 billion over its first ten years, and would lower the cost of premiums. It would also newly insure approximately 1.1 million Americans per $20 billion spent. The Senate bill, in contrast, is far less efficient, and would only insure 260,000 Americans per $20 billion.

With respect to the individual provisions in the small bill, the Times predictably criticizes the expansion of the insurance market by allowing people to purchase insurance in any state. The Times also minimizes the importance of medical-malpractice reform, which the CBO has said will save the federal government alone $54 billion over ten years (and more than double that for the system as a whole). Still, as for the argument that medical-malpractice litigation drives up costs, the Times acknowledges that “they [Republicans] are right” so we will take that as a win. As for Health Savings Accounts, the Times notes that expanding the amount that individuals can save tax free to pay for routine medical expenses “seems reasonable,” although they feel this idea would mostly help those in higher income brackets. Finally, they seem okay with the idea of high-risk pools, but say that they need to be “granted substantially more money than the Republicans are likely to commit.” (The small bill, for the record, calls for quadrupling the amount the House Republican bill allocates to high-risk pools).

So the scorecard on four ideas that are in the small bill reads that the GOP is “right” on one, another “seems reasonable,” and a third is okay if we spend an unspecified larger sum. Finally, the Times appears to see as a weakness the notion that the Republican ideas “primarily affect people who buy their own policies or work for small businesses, not the vast majority who get their insurance through larger employers.” Republican ideas are indeed focused on those who want to buy insurance on their own or who work for small businesses, because that is where the bulk of the problem lies. If we have learned one thing from the health-care debate over the last year or so, it is that this “vast majority who get their insurance through larger employers” are the ones who least want the current system messed with.

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