GOP health bill shows challenge of health insurance reform

   With the debate on health care reform headed to the House floor -- late this week or early next -- Republicans have offered an alternative of their own (attached below) that they promise won't raise taxes, change the doctor-patient relationship, or cut Medicare. 

   The Democrats' bill does all three.

   But the GOP alternative also shows why health care reform is so tough:  Each piece of health care reform interlocks with the others.

   The Republican bill, for example, doesn't force insurance companies to provide coverage for those with pre-existing conditions (instead, it wants to provide money to states to establish "high risk" pools for older, sicker people.)

    Why would the GOP not protect people with pre-existing conditions?  That's one of the most popular part of health care reform -- everyone is scared of not being able to buy insurance because of a previous illness.

    Here's why:  Insurance companies have repeatedly said they can cover those with pre-existing conditions only if everyone has to buy insurance.  Premiums from healthier workers, they say, will cover the costs of those with illnesses.

   But if you require everyone to have insurance, you're deep in the muck.  Do you fine people who don't get it?  Do you require businesses to provide it?  What about people who can't afford premiums now -- are they subsidized?

   And if you subsidize premiums for the poor, you have to find a way to pay for it.  Raise taxes?  Cut other spending (like Medicare)?  Let the deficit grow even bigger?

    Soon you're in 2000-page bill territory.

    The GOP could just force companies to take all customers, but insurers say that would bankrupt them -- even if Republicans were fond of requiring private industry to do something, which they're not.

     Other parts of the bill interlock, too.  Cut payments to doctors and hospitals -- to lower costs -- and suddenly there aren't enough providers in some parts of the country.  Fix that and costs go back up.  Set up a public option alternative to private companies and less money is available to cover those privately insured, leading to higher premiums, which leads to fewer people buying insurance, which leads to higher public support for premiums... you get the picture.

    There have been other alternatives, from single-payer on the left to the virtual elimination of insurance except for catastrophic illness on the right.  Those approaches got little attention.

   Instead, Democrats and Republicans are trying to glue some very different parts onto a model without an instruction sheet.  No wonder it's so complicated.