Via Ezra Klein's tab dump, I see Louisiana Gov. Bobby Jindal wrote an op-ed yesterday in the Washington Post about how Republicans should approach health care reform. It's unlikely that Republicans will approach health care reform in any meaningful way, but I was still interested in reading how Jindal, allegedly one of the unabashed wiz-kid wonks of the Republican Party, wanted to fix health care. At the end of the day, his ideas are good -- many of them are in the Baucus bill already -- but his understanding of the health care debate is just weird.


Let's start here:

Democratic plans for a government takeover are passé. The people don't want it. Believe the polls

Totally 180 degrees wrong. The polls consistently show 65 percent approval of a government-run insurance plan. In fact a public option is more popular than health care reform, and two to three times more popular than the Republican Party.

Only Democrats in Washington would propose new taxes on businesses and families in the middle of a recession, $900 billion in new spending at a time of record deficits, and increased taxes on health insurance and products to reduce health-care costs.

Not true. It's not only Democrats who would increase taxes on health insurance. Sen. McCain floated the idea of taxing employer provided health insurance in his campaign. In May 2009 (when the recession was even worse) Rep. Paul Ryan's health care plan proposed taxing those plans too. Those GOP plans would probably increase the tax on employer provided care even more than Democrats, since Republicans want to dismantle our employer-based insurance model and replace it with individual tax credits. Whether or not you like that idea, let's call it what it is: a tax to move millions of people off employer insurance rosters. Later Jindal writes...

The public is interested in solutions that will improve America's health-care system, not dismantle it.

... but that's exactly what Republican plans would do. What Senate Democrats are offering is, if anything, a disappointingly vanilla reform. They're keeping the employer provided model and spending $1 trillion over ten years to expand coverage to people who can't afford to buy it themselves. If you want to slam it for building on a system that doesn't work, that's a reasonable critique. But slamming Senate Democrats for "dismantling" health care is like suing your construction company for burglary and arson because they expanded your kitchen and added a third bathroom. It just doesn't make any sense.

Finally Jindal gets to his top ten reform ideas. Most of them are, as Ezra pointed out briefly, really familiar to Democrats.

-- Voluntary purchasing pools: Give individuals and small businesses the opportunities that large businesses and the government have to seek lower insurance costs.

-- Portability: As people change jobs or move across state lines, they change insurance plans. By allowing consumers to "own" their policies, insurers would have incentive to make more investments in prevention and in managing chronic conditions.

-- Lawsuit reform: It makes no sense to ignore one of the biggest cost drivers in the system -- the cost of defensive medicine, largely driven by lawsuits. Worse, many doctors have stopped performing high-risk procedures for fear of liability.

-- Require coverage of preexisting conditions: Insurance should not be least accessible when it is needed most. Companies should be incentivized to focus on delivering high-quality effective care, not to avoid covering the sick.

-- Transparency and payment reform: Consumers have more information when choosing a car or restaurant than when selecting a health-care provider. Provider quality and cost should be plainly available to consumers, and payment systems should be based on outcomes, not volume. Today's system results in wide variations in treatment instead of the consistent application of best practices. We must reward efficiency and quality.

-- Electronic medical records: The current system of paper records threatens patient privacy and leads to bad outcomes and higher costs.

-- Tax-free health savings accounts: HSAs have helped reduce costs for employers and consumers. Some businesses have seen their costs decrease by double-digit percentages. But current regulations discourage individuals and small businesses from utilizing HSAs.

-- Reward healthy lifestyle choices: Providing premium rebates and other incentives to people who make healthy choices or participate in management of their chronic diseases has been shown to reduce costs and improve health.

-- Cover young adults: A large portion of the uninsured are people who cannot afford coverage after they have "aged out" of their parents' policies. Permitting young people to stay on their parents' plans longer would reduce the number of uninsured and keep healthy people in insurance risk pools -- helping to lower premiums for everyone.

-- Refundable tax credits (for the uninsured and those who would benefit from greater flexibility of coverage): Redirecting some of the billions already spent on the uninsured will help make non-emergency care outside the emergency room affordable for millions and will provide choices of coverage through the private market rather than forcing people into a government-run system. We should trust American families to make choices for themselves while we ensure they have access to quality, affordable health care.

Those are some good ideas! Many are firmly stitched into the Democratic plans, especially electronic medical records funding (it's from the stimulus Jindal hated), transparency in the exchanges, coverage of pre-existing conditions, coverage of young adults and subsidizing the uninsured. Tort reform I think is overrated, but I don't object to it. Health insurance accounts were the silver bullet in this well-read Atlantic health care article, but the argument there was precisely to dismantle our health care system, so I'm not sure if a vast network of HSAs would would work running alongside an employer-based model. But for the most part, it's such a solidly Democratic list, it makes you wonder why exactly zero Republicans will vote for the bill.

But equally notable is what isn't in the list. Anything explaining how we should approach pay-for-quality rather than pay-for-service. Anything in the realm of revenue to expand coverage. The word Medicare. I like the latter half of Jindal's op-ed, but but I can't help feeling that this health care buffet is a set of appetizers in search of an entree idea.

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