The Billings Gazette on Monday turned over most of its editorial page to the three candidates for the U.S. House to replace Ryan Zinke. If you haven’t already read their columns, you should skip them because they might make you sick, and these guys have no idea what to do about that.
Let’s attempt a nontoxic version of their healthcare plans, starting with the one candidate we know won’t win: Mark Wicks, the Libertarian candidate. Wicks’ approach has the virtue of blatant hypocrisy. He begins by saying that the federal government has no constitutional authority to manage healthcare. He follows with a couple of Affordable Care Act horror stories, then concludes by stating, “I will rollback the ACA while protecting Medicaid and Medicare until a long-term solution is found.”
It’s true that the Constitution says nothing about healthcare, which is a good thing. Given the state of 18th century medicine, guaranteed healthcare probably would have killed us off before we even got to the Civil War. But Medicaid and Medicare are far more intrusive, and more long-term, impositions of federal power than the ACA, which attempts, however ineptly, to marshal market forces to provide universal coverage.
Wicks doesn’t even say whether he would preserve ACA’s Medicaid expansion, which is largely responsible for reducing the percentage of uninsured Americans to the lowest in history.
Greg Gianforte, the Republican candidate, is more subtly hypocritical. Gianforte wants lower premiums and lower prescription prices, and he wants to preserve insurance for those with preexisting conditions. But he provides no clue how he would do that.
He opposes the ACA, and he opposes its Republican replacement, the American Health Care Act, a bill so poorly conceived that it united the House’s most liberal Democrats and most conservative Republicans in a rare show of bipartisan agreement: They all hated it.
What does Gianforte favor? Two old Republican war horses: selling insurance across state lines and reforming malpractice to eliminate “frivolous” lawsuits.
Not even the two most prominent conservative think tanks, the Heritage Foundation and the American Enterprise Institute, think that selling insurance across state lines would save much money. The cost of medical malpractice in the United States was estimated in a 2010 study at 2.4 percent of total healthcare costs, including defensive medicine practiced just to avoid lawsuits.
That’s real money, but suppose that malpractice costs were reduced to zero, which would happen only if humans stopped making errors or if patients were deprived of all recourse for medical malpractice. America would still have by far the highest medical costs in the world.
Instead of policy, Gianforte rolls out pat phrases: “Nancy Pelosi,” “career bureaucrat,” “death spiral,” “government takeover,” “dictating and rationing.” These aren’t merely dog whistles; this is like teaching a dog to sit and imagining it has learned Plato’s dialogues.
Democratic candidate Rob Quist rolls out his own medical history, apparently to make the point that illness makes you not only sick but unable to pay your bills (he has a history of not paying bills). He does defend the ACA, although he is as vague as Gianforte when it comes to fixing the law’s obvious shortcomings. Nor does he have much to say about prescription drug prices, other than a vague promise to “stand against pharmaceutical companies.”
To his credit, Quist does offer one sound suggestion: increase transparency in healthcare costs. One reason costs are so high is that it’s so hard to know what procedures cost, and they can vary wildly. One study found the cost of an MRI varied from $700 to $1,200 to $3,000 at three hospitals within 15 miles of each other.
Even after a hospital visit, it’s hard to know what it actually cost. We once got turned over to collections for a medical bill we had no idea we owed. When I explained that to a representative at the collection agency, he gave me an answer I have never forgotten: “I’m not surprised.”
The ACA has taken some steps to increase transparency, but Montana could do more all by itself. A report in July listed Montana as one of 43 states to get a grade of F for healthcare price transparency.
One reason was the lack of an all-payer claims database, an online resource that gathers information from a variety of sources to tell patients what they actually have to pay for care, not just what the often confusing charges are. The 2011 Montana Legislature called for a feasibility study and created an advisory council to look at the issue, but nothing came of it.
A bill in 2015 that would have created an APCD in Montana passed out of committee but failed to make the transmittal deadline. It would have cost more than $1 million to create the database and hire an employee to maintain it. But it might well have paid for itself.
Here’s another way to save money: Stop fighting the Clean Power Plan, which was projected to prevent 90,000 asthma attacks and 3,600 premature deaths a year by 2030. According to the American Lung Association, half of all Americans live in counties with unhealthy air.
Maybe if our elected representatives can’t figure out a way to pay for our healthcare, they could at least agree to stop making us sicker.