Mitt Romney’s No Apology 7: Health Care

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.

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