A presidential nominee acceptance speech probably is not the place to explain how you plan to fix healthcare in the United States, but Mitt Romney last night offered zero detail on what he would put in place of the Patient Protection and Affordable Care Act.
The official party platform, on the other hand, covers many facets of the US healthcare system and what the Republicans plan to do. “A Republican President, on the first day in office, will use his legitimate waiver authority under that law to halt its progress and then will sign its repeal,” states the platform. The Republicans in Congress and the president, should Romney win, will replace the ACA with a mixture of regulations for insurers, legislation that encourages personal responsibility for maintaining a healthy lifestyle, tort reform, price transparency, and tax breaks for the self-insured.
The Patient Protection and Affordable Care Act – Obamacare – was never really about healthcare, though its impact upon the nation’s health is disastrous. From its start, it was about power, the expansion of government control over one sixth of our economy, and resulted in an attack on our Constitution, by requiring that U.S. citizens purchase health insurance. We agree with the four dissenting justices of the Supreme Court: “In our view the entire Act before us is invalid in its entirety.” It was the high-water mark of an outdated liberalism, the latest attempt to impose upon Americans a euro-style bureaucracy to manage all aspects of their lives. Obamacare has been struck down in the court of public opinion and is falling by the weight of its own confusing, unworkable, budget-busting, and conflicting provisions. It would tremendously expand Medicaid without significant reform, leaving the States to assume unsustainable financial burdens. If fully implemented, it could not function; and Republican victories in the November elections will guarantee that it is never implemented. Congressional Republicans are committed to its repeal; and a Republican President, on the first day in office, will use his legitimate waiver authority under that law to halt its progress and then will sign its repeal. Then the American people, through the free market, can advance affordable and responsible healthcare reform that meets the needs and concerns of patients and providers. Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.
Our Prescription for American Healthcare: Improve Quality and Lower Costs
We believe that taking care of one’s health is an individual responsibility. Chronic diseases, many of them related to lifestyle, drive healthcare costs, accounting for more than 75 percent of the nation’s medical spending. To reduce demand, and thereby lower costs, we must foster personal responsibility while increasing preventive services to promote healthy lifestyles. We believe that all Americans should have improved access to affordable, coordinated, quality healthcare, including individuals struggling with mental illness.
Our goal is to encourage the development of a healthcare system that provides higher quality care at a lower cost to all Americans while protecting the patient-physician relationship based on mutual trust, informed consent, and privileged patient confidentiality. We seek to increase healthcare choice and options, contain costs and reduce mandates, simplify the system for patients and providers, restore cuts made to Medicare, and equalize the tax treatment of group and individual health insurance plans. For most Americans, those who are insured now or who seek insurance in the future, our practical, non-intrusive reforms will promote flexibility in State leadership in healthcare reform, promote a free-market based system, and empower consumer choice. All of which will return direction of the nation’s healthcare to the people and away from the federal government.
To return the States to their proper role of regulating local insurance markets and caring for the needy, we propose to block grant Medicaid and other payments to the States; limit federal requirements on both private insurance and Medicaid; assist all patients, including those with pre-existing conditions, through reinsurance and risk adjustment; and promote non-litigation alternatives for dispute resolution. We call on State officials to carefully consider the increased costs of medical mandates, imposed under their laws, which may price many low-income families out of the insurance market. We call on the government to permanently ban all federal funding and subsidies for abortion and healthcare plans that include abortion coverage.
To achieve a free market in healthcare and ensure competition, we will promote price transparency so that consumers will know the actual cost of treatments before they undergo them. When patients are aware of costs, they are less likely to over-utilize services. We support legislation to cap non-economic damages in medical malpractice lawsuits, thereby relieving conscientious providers of burdens that are not rightly theirs and addressing a serious cause of escalating medical bills. We will empower individuals and small businesses to form purchasing pools in order to expand coverage to the uninsured. Individuals with pre-existing conditions who maintain continuous insurance coverage should be protected from discrimination. We support technology enhancements for medical health records and data systems while affirming patient privacy and ownership of health information.
Ensuring Consumer Choice in Healthcare
Consumer choice is the most powerful factor in healthcare reform. Today’s highly mobile work force requires portability of insurance coverage that can go with them from job to job. The need to maintain coverage should not dictate where families have to live and work. Putting the patient at the center of policy decisions will increase choice and reduce costs while ensuring that services provide what Americans actually want. We must end tax discrimination against the individual purchase of insurance and allow consumers to purchase insurance across State lines. While promoting “co-insurance” products and alternatives to “fee for service,” government must promote Health Savings Accounts and Health Reimbursement Accounts to be used for insurance premiums and should encourage the private sector to rate competing insurance plans. We will ensure that America’s aging population has access to safe and affordable care. Because seniors overwhelmingly desire to age at home, we will make home care a priority in public policy. We will champion the right of individual choice in senior care. We will aggressively implement programs to protect against elder abuse, and we will work to ensure that quality care is provided across the care continuum from home to nursing home to hospice.
Supporting Federal Healthcare Research and Development
We support federal investment in healthcare delivery systems and solutions creating innovative means to provide greater, more cost-effective access to high quality healthcare. We also support federal investment in basic and applied biomedical research, especially the neuroscience research that may hold great potential for dealing with diseases and disorders such as Autism, Alzheimer’s, and Parkinson’s. If we are to make significant headway against breast and prostate cancer, diabetes, and other killers, research must consider the special needs of formerly neglected groups. We call for expanded support for the stem-cell research that now offers the greatest hope for many afflictions – with adult stem cells, umbilical cord blood, and cells reprogrammed into pluripotent stem cells-without the destruction of embryonic human life. We urge a ban on human cloning and on the creation of or experimentation on human embryos. We support restoring the Drug Enforcement Administration ban on the use of controlled substances for physician-assisted suicide. We oppose the FDA approval of Mifeprex, formerly known as RU-486, and similar drugs that terminate innocent human life after conception.
Protecting Individual Conscience in Healthcare
No healthcare professional or organization should ever be required to perform, provide for, withhold, or refer for a medical service against their conscience. This is especially true of the religious organizations which deliver a major portion of America’s healthcare, a service rooted in the charity of faith communities. We do not believe, however, that healthcare providers should be allowed to withhold services because the healthcare provider believes the patient’s life is not worth living. We support the ability of all organizations to provide, purchase, or enroll in healthcare coverage consistent with their religious, moral or ethical convictions without discrimination or penalty. We likewise support the right of parents to consent to medical treatment for their children, including mental health treatment, drug treatment, and treatment involving pregnancy, contraceptives and abortion.
Reforming the FDA
America’s leadership in life sciences R&D and medical innovation is being threatened. As a country, we must work together now or lose our leadership position in medical innovation, U.S. job creation, and access to life-saving treatments for U.S. patients. The United States has led the global medical device and pharmaceutical industries for decades. This leadership has made the U.S. the medical innovation capital of the world, bringing millions of high-paying jobs to our country and life-saving devices and drugs to our nation’s patients. But that leadership position is at risk; patients, innovators, and job creators point to the lack of predictability, consistency, transparency and efficiency at the Food and Drug Administration that is driving innovation overseas, benefiting foreign, not U.S., patients. We pledge to reform the FDA so we can ensure that the U.S. remains the world leader in medical innovation, that device and drug jobs stay in the U.S., that U.S. patients benefit first from new devices and drugs, and that the FDA no longer wastes U.S. taxpayer and innovators’ resources because of bureaucratic red tape and legal uncertainty.
Reducing Costs through Tort Reform
Frivolous medical malpractice lawsuits have ballooned the cost of healthcare for the average American. Physicians are increasingly practicing defensive medicine because of the looming threat of malpractice liability. Moreover, some medical practitioners are avoiding patients with complex and high-risk medical problems because of the high costs of medical malpractice lawsuits. Rural America is hurt especially hard as obstetricians, surgeons, and other healthcare providers are moving to urban settings or retiring, causing a significant healthcare workforce shortage and subsequently decreasing access to care for all patients. We are committed to aggressively pursuing tort reform legislation to help avoid the practice of defensive medicine, to keep healthcare costs low, and improve healthcare quality.
For much of the last century, an opposing view has dominated public policy where we have witnessed the expansion, centralization, and bureaucracy in an entitlement society. Government has lumbered on, stifling innovation, with no incentive for fundamental change, through antiquated programs begun generations ago and now ill-suited to present needs and future requirements. As a result, today’s taxpayers – and future generations – face massive indebtedness, while Congressional Democrats and the current Administration block every attempt to turn things around. This man-made log-jam – the so-called stalemate in Washington – particularly affects the government’s three largest programs, which have become central to the lives of untold millions of Americans: Medicare, Medicaid, and Social Security.
The Republican Party is committed to saving Medicare and Medicaid. Unless the programs’ fiscal ship is righted, the individuals hurt the first and the worst will be those who depend on them the most. We will save Medicare by modernizing it, by empowering its participants, and by putting it on a secure financial footing. This will be an enormous undertaking, and it should be a non-partisan one. We welcome to the effort all who sincerely want to ensure the future for our seniors and the poor. Republicans are determined to achieve that goal with a candid and honest presentation of the problem and its solutions to the American people.
Despite the enormous differences between Medicare and Medicaid, the two programs share the same fiscal outlook: their current courses cannot be sustained. Medicare has grown from more than 20 million enrolled in 1970 to more than 47 million enrolled today, with a projected total of 80 million in 2030. Medicaid counted almost 30 million enrollees in 1990, has about 54 million now, and under Obamacare would include an additional 11 million. Medicare spent more than $520 billion in 2010 and has close to $37 trillion in unfunded obligations, while total Medicaid spending will more than double by 2019. In many States, Medicaid’s mandates and inflexible bureaucracy have become a budgetary black hole, growing faster than most other budget lines and devouring funding for many other essential governmental functions.
The problem goes beyond finances. Poor quality healthcare is the most expensive type of care because it prolongs affliction and leads to ever more complications. Even expensive prevention is preferable to more costly treatment later on. When approximately 80 percent of healthcare costs are related to lifestyle -smoking, obesity, substance abuse-far greater emphasis has to be put upon personal responsibility for health maintenance. Our goal for both Medicare and Medicaid must be to assure that every participant receives the amount of care they need at the time they need it, whether for an expectant mother and her baby or for someone in the last moments of life. Absent reforms, these two programs are headed for bankruptcy that will endanger care for seniors and the poor.
The first step is to move the two programs away from their current unsustainable defined-benefit entitlement model to a fiscally sound defined-contribution model. This is the only way to limit costs and restore consumer choice for patients and introduce competition; for in healthcare, as in any other sector of the economy, genuine competition is the best guarantee of better care at lower cost. It is also the best guard against the fraud and abuse that have plagued Medicare in its isolation from free market forces, which in turn costs the taxpayers billions of dollars every year. We can do this without making any changes for those 55 and older. While retaining the option of traditional Medicare in competition with private plans, we call for a transition to a premium-support model for Medicare, with an income-adjusted contribution toward a health plan of the enrollee’s choice. This model will include private health insurance plans that provide catastrophic protection, to ensure the continuation of doctor-patient relationships. Without disadvantaging retirees or those nearing retirement, the age eligibility for Medicare must be made more realistic in terms of today’s longer life span.
Strengthening Medicaid in the States
Medicaid, as the dominant payer in the health market in regards to long-term care, births, and individuals with mental illness, is the next frontier of welfare reform. It is simply too big and too flawed to be managed in its current condition from Washington. Republican Governors have taken the lead in proposing a host of regulatory changes that could make the program more flexible, innovative, and accountable. There should be alternatives to hospitalization for chronic health problems. Patients could be rewarded for participating in disease prevention activities. Excessive mandates on coverage should be eliminated. Patients with long-term care needs might fare better in a separately designed program.
As those and other specific proposals show, Republican Governors and State legislatures are ready to do the hard work of modernizing Medicaid for the twenty-first century. We propose to let them do all that and more by block-granting the program to the States, providing the States with the flexibility to design programs that meet the needs of their low income citizens. Such reforms could be achieved through premium supports or a refundable tax credit, allowing non-disabled adults and children to be moved into private health insurance of their choice, where their needs can be met on the same basis as those of more affluent Americans. For the aged and disabled under Medicaid, for whom monthly costs can be extremely high, States would have flexibility to improve the quality of care and to avoid the inappropriate institutional placing of patients who prefer to be cared for at home.
Balancing the Budget
“Cutting spending is not enough; it must be accompanied by major structural reforms, increased productivity, use of technology, and long-term government downsizing that both reduce debt and deficits and ignite economic growth. We must restructure the twentieth century entitlement state so the missions of important programs can succeed in the twenty-first century. Medicare, in particular, is the largest driver of future debt. Our reform of healthcare will empower millions of seniors to control their personal healthcare decisions, unlike Obamacare that empowered a handful of bureaucrats to cut Medicare in ways that will deny care for the elderly.
The most offensive instance of this war on religion has been the current Administration’s attempt to compel faith-related institutions, as well as believing individuals, to contravene their deeply held religious, moral, or ethical beliefs regarding health services, traditional marriage, or abortion. This forcible secularization of religious and religiously affiliated organizations, including faith-based hospitals and colleges, has been in tandem with the current Administration’s audacity in declaring which faith-related activities are, or are not, protected by the First Amendment – an unprecedented aggression repudiated by a unanimous Supreme Court in its Hosanna-Tabor v. EEOC decision. We pledge to respect the religious beliefs and rights of conscience of all Americans and to safeguard the independence of their institutions from government.
Sanctity and Dignity of Human Life
We also salute the many States that have passed laws for informed consent, mandatory waiting periods prior to an abortion, and health-protective clinic regulation.
Supporting our Troops
The spiritual welfare of our troops and retired service members should be a priority of our national leadership. With military suicides running at the rate of one a day, with post-service medical conditions, including addiction and mental illness, and with the financial stress and homelessness that is often related to these factors, there is an urgent need for the kind of counseling that faith-based institutions can best provide. We support rights of conscience and religious freedom for military chaplains and people of faith. A Republican Commander in Chief will protect religious independence of military chaplains and will not tolerate attempts to ban Bibles or religious symbols from military facilities. We will enforce and defend in court the Defense of Marriage Act (DOMA) in the Armed Forces as well as in the civilian world.
Recognizing and Supporting Military Families
The families of our military personnel currently serving, retired service members, and veterans must also be assured of the pay, health care, housing, education, and overall support they have earned. We will ensure that the federal government keeps its commitments to those who signed on the dotted line of enlistment with the assurance that those promises would be kept. We must also do more to retain the services of those service members who have borne the fight since 2001.
Honoring and Supporting Our Veterans: A Sacred Obligation
America has a sacred trust with our veterans, and we are committed to providing them and their families with care and dignity. This is particularly true because our nation’s warriors are volunteers, who served from a sense of duty. The work of the Department of Veterans Affairs – with a staff of 300,000 – is essential to meet our obligations to them: providing health, education, disability, survivor, and home loan benefit services and arranging memorial services upon death. All its branches in those various fields must be made more responsive, moving from an adversarial to an advocacy relationship with veterans. To that end we will consider a fundamental change in structure to make the regional directors of the Department presidential appointees rather than careerists.
Our wounded warriors, whether still in service or discharged, deserve the best medical care our country can provide. The nature of the fighting in Iraq and Afghanistan has resulted in an unprecedented incidence of traumatic brain injury, loss of limbs, and post-traumatic stress disorder which calls for a new commitment of resources and personnel for its treatment and care to promote recovery. We must make military and veterans’ medicine the gold standard for mental health care, advances in prosthetics, and treatment of trauma and eye injuries. We must heed Abraham Lincoln’s command “to care for him who bore the battle.” To care, as well, for the families of those who have made the ultimate sacrifice, who must be assured of meaningful financial assistance, remains our solemn duty.
Because the conditions of warfare have changed dramatically since the war on terror began, today’s veterans face new challenges. Asymmetrical or non-traditional warfare results in a high incidence of severe conditions that must receive high priority and call for continued research into prevention and treatment.