I read the chapter on health care in Mitt Romney's No Apology: Believe in America. There were a variety of things that I liked about this chapter.
First
of all, Romney talked honestly about his health care plan in
Massachusetts, as he says where it has worked and where it has been
inadequate. According to Romney, it worked in that it provided
more people with health insurance coverage and brought down some
people's premiums. But Romney is honest that health care costs are
still high, and thus many premiums remain high as well.
Second,
Romney is forthright about what he believes are the strengths and
weaknesses of certain proposals to bring down the costs of health care.
Newt Gingrich often touts computerizing health care records as a
way to bring down costs. While Romney supports this because it can
lead to efficiency, he refers to a study that says that computerization
did not bring down health care costs significantly. For
Romney, computerization has to work in tandem with other things for
costs to come down (and Newt would probably agree with that, even though
Newt is more optimistic about the effectiveness of computerization in
reducing costs).
Third, Romney explained some things that other
Republican candidates I read did not explain too well. Newt Gingrich
and Tim Pawlenty say that health insurance is an open bar for many
people, and my problem with that sentiment is that there are people who
pay high deductibles, co-pays, and premiums, meaning that they are not
immune from the costs of health care. But, according to Romney, there
are many people who can get any health care that they want after their
deductible is paid. I should also note that, in some cases in which
people receive health insurance through their companies, they may not be
exposed to its cost.
Fourth, Romney explained in more detail his
belief that health insurance should move away from the fee-for-service
model and towards a model of giving doctors lump-sums. According to
Romney, if a person has a certain condition, the health insurance
company, Medicare, or Medicaid should give the doctors a lump-sum so
that they can diagnose and treat that condition, rather than reimbursing
them for every test and treatment that they do----which only
incentivizes more tests and treatments, some of which can be
unnecessary, and perhaps even dangerous. Romney may believe
that doctors will try to make the best use that they can out of the
lump-sum----as they work on getting results. I fear that this
is rationing, and that the lump-sum will not always be big enough to
cover all of the patient's medical costs. But I recognize that the
fee-for-service model is problematic and cannot think of another
alternative.
Fifth, Romney tells anecdotes, which shows that he
has a personal connection with the health care issue. He talks about
the people he visited as a Mormon official, who were struggling with
America's health care system. And he tells about his son Josh,
who lived in England. Josh's physician thought that Josh might have
colon cancer, but Josh in England would have to wait six weeks for his
colonoscopy, during which time the cancer could become inoperable and
terminal. But Josh received a "timely examination" in Massachusetts (page 199).
Sixth,
I appreciated something that Romney said on page 196: "If Americans
enjoyed better health and longevity than people in other countries, it
might be reasonable to argue that our excessive health-care spending is
simply a rational consumer choice. But the life span of the average
American is less than that of people in nations that spend far less.
Japanese men outlive American men by five years; Frenchmen outlive us by
three years. To put it bluntly, we spend more and die sooner. Most of
the difference is explained by Americans' unhealthy lifestyles..."
Later,
Romney argues that U.S. health care is superior due to its competence,
but I like what Romney says on page 196 because it can be used to
support a single-payer system (which Romney opposes). There are
countries that have single-payer systems, and their citizens live longer
than people who are in the United States. A concern I have about
applying a single-payer system to the U.S., however, is that Americans
tend to live unhealthy lifestyles, and so I fear that a single-payer
system here could break the bank or result in really high tax rates. At
the same time, it could encourage people to visit the doctor more and
receive preventative care and advice on how to live a healthy lifestyle,
and that could reduce health care costs.