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Michael Berson in a recent post quotes a twitter exchange that asks Rep. Vicky Hartzler (R-4) to essentially put up or shut up when it comes to Obamacare by specifying how she would replace it. Surprise, surprise – Harzler is prepared for just such querries:

West-Central Missouri Representative Vicky Hartzler admits that the Republican party may have spent too much time battling the Affordable Care Act. But now, she’s cosponsoring an alternative bill. It’s called the American Healthcare Reform Act. [i.e.,H.R 3121 (pdf)].

“Our plan would allow more competition across state lines and more individual control over decisions between doctors and patients. It would also allow for some tort reform, which is a real cost driver. It also supervises ways for people who can’t get insurance to access it through high-risk pools,” she said.

Seems to me that I’ve heard these proposals before. Weren’t these the best ideas that John McCain could manage? And, of course there was the three-page alterntive to Obamacare that Roy Blunt and his GOP working group produced way back when, which might have hit the same high (or low) points if I remember correctly. The points Hartzler specifies are simply those every GOP hack flourishes when put on the spot about an alternative to Obamacare.

The most recent of those hacks to pull out the tried-and-true GOP healthcare wish list is Sarah Palin – or at least I think that was what she was trying to do during a typically incoherent interview with Matt Lauer yesterday:

The plan is to allow those things that had been proposed over many years to reform a health-care system in America that certainly does need more help so that there’s more competition, there’s less tort reform threat, there’s less trajectory of the cost increases, and those plans have been proposed over and over again. And what thwarts those plans? It’s the far left. It’s President Obama and his supporters who will not allow the Republicans to usher in free market, patient-centered, doctor-patient relationship links to reform health care.

Hunh? “Less tort reform threat”? At least we now know how Vicky Harzler differs from Sarah Palin. Both espouse the same silly ideas but one of them speaks English.

And the ideas in H.R 3121, which it’s safe to assume Palin would endorse, are silly, especially when presented as an alternative to systematic reform. Some are harmless bits of fiddling that  would have minimal impact on the problems of our healthcare delivery system, others are downright harmful, and some are simply gifts to the insurance industry – purchasing insurance across state lines, for instance. As formulated in HR3121 it seems to me that the point is to permit out-of-state insurers to flout state-based consumer protections in the name of competition.

Consider also the GOP standby, tort reform. HR3121 follows the usual pattern of instituting caps on non-economic and punitive damages. It also allows the court discretion to redirect attorney’s fees to clients in some cases. According to Adam Dawson, who has analysed the results of a similar reform in Texas, “tt’s a terrific plan, except for the fact that it’s a terrible plan.” Some of the most salient results of the Texas experiment:

One of the more optimistic predictions was that doctors would simply stampede to Texas in order to set up practice thanks to Governor Perry’s legal protections. But the latest info from the American Association of Medical Colleges has Texas ranking 42nd in the country in doctors per 100,000 people. […]

Also torpedoed by the facts is the notion that tort reform causes health insurance premiums to drop. Between 2003 and 2010 the average price of a health insurance premium for an individual in Texas went up 46 percent, and the average price of a family health insurance plan in Texas went up 52 percent. As if that wasn’t enough of a sign that tort reform hasn’t helped make health care cheaper, Texas had one of the highest rates of uninsured people in the country in 2010. […]

[…] in McAllen, Texas, Medicare costs per person are actually higher than the median income of the people who live there. While doctors might no longer fear lawsuits, it seems they are also not at all afraid of sending big, fat, test-laden invoices to Uncle Sam or insurance companies. It doesn’t seem to be “defensive medicine” as much as it is an amendment to the Hippocratic Oath: “First, do no harm. Second, daddy needs a new pair of shoes.”

It is absolutely true that medical malpractice cases have dropped drastically in Texas, but doctors and surgeons are making just as many mistakes as they always have. It’s just that now most of the victims have been priced out of the courtroom. […]

HR3121 also, as Hartzler noted, proposes high-risk pools as a way to answer criticisms that our current system leaves those with pre-existing conditions without coverage.  High-risk pools were one of the centerpieces of John McCain’s healthcare proposals and, as I recollect, nobody was too impressed then, nor should they be now, Our experience with high-risk pools in the past has shown that they are not very effective in providing health care; they tend to be prohibitively expensive and often offer inadequate coverage. Many individuals are expected to get better deals by leaving existing state-run high-risk pools and purchasing insurance through the Obamacare exchanges.

All of which brings me back to the difference between Vicky Harzler and Sarah Palin. Their similarities are actually more important than their differences since in GOP circles whether or not one can manipulate English syntax is not so important as being able to get all the buzz words out in public as fast as possible. And when it comes to generating empty noise, both women get a gold star.

*Edited slightly for clarity.