Meddling Bureaucrats and the Health-Care Summit.

During the health-care summit, both Obama and Biden tried to make the point that both Republicans and Democrats agree that there should be some government regulation of health care; they're just disagreeing about exactly how much. As they observed, GOP members of Congress have signed on to certain kinds of regulation (the popular kinds), like ending recissions (where your insurance company kicks you off your policy when you get sick) and even outlawing denials for pre-existing conditions, which is a large change with serious implications.

Nevertheless, Republican rhetoric in criticizing the Democrats' plan continues to be about "putting Washington in charge" of health-care decisions, "putting a government bureaucrat between you and your doctor," and so on. This is supposed to be in contrast to "letting patients and doctors decide." The problem is this last part -- they have a vision of a fantasy world where insurance companies don't exist. You go to your doctor, you and she decide on your treatment, and presto, treatment is given and payment happens. If you have really, really good coverage -- the kind, not coincidentally, members of Congress have -- and you've never had a serious illness, it actually feels this way. The negotiation between your doctor and your insurance company is basically invisible to you.

But that doesn't mean that negotiation isn't happening, and it won't eventually affect you. During the summit, Rep. Eric Cantor objected vehemently to the idea that within a health insurance exchange, the government would set a minimum standard of benefits insurers had to meet. Washington! Government! Bureaucrats! But somebody has to decide what that minimum is, and if it's not Washington, it isn't going to be "you and your doctor" -- it's going to be your insurance company. Ezra Klein has a nice explanation of how the Democrats' bill works on this score, and as he observes, if we were to accept the Republicans' idea -- let people buy insurance across state lines -- there would be a national standard, "but rather than being decided by Washington, it will be decided by whichever state has the most lax insurance regulations. We'd have a national standard being written by South Dakota's legislature, which would be a strange fate indeed."

The opponents of health-care reform don't like talking about the abuses insurance companies commit, or the fundamental pathology of a profit-driven health insurance system, which is that the insurer's incentive will always be to take as much of your money as possible in premiums and pay for as little care as possible. Their rhetoric exists in this dream world where insurance companies aren't actually making decisions that affect people's lives. But they are. Insurance company bureaucrats get between people and their doctors every day. If it hasn't happened to you in a way that was obvious, then you've been fortunate.

--Paul Waldman

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