The Republican Health-Care Surrender

By DICK ARMEY

Hillary Clinton's presidential aspirations may have died in North Carolina last week, but her most famous bad idea is alive and well in Washington, D.C. With likely increases in Democrat ranks in the House and Senate, and a Democrat (possibly) in the White House, plan on a big fight in 2009 over who - you or the federal government - will control your family's health-care decisions.

We won this fight last time around. One of the GOP's shining moments was our principled opposition to HillaryCare in 1994. The first lady's overreach helped lay the groundwork for the Republican takeover of Congress that November. We may not be so lucky next time. While the Democratic Party appears unified under the banner of big-government health care, the GOP seems conflicted and running scared. This is a classic case of Republicans being afraid that the public will not understand good policy reforms. Rather than promoting the principles of consumer choice, individual responsibility and provider competition that would transform our broken health-care system, key Republicans are bowing to political pressure and signing on with the government-run health-care Democrats.

Emblematic of this phenomenon is Iowa Sen. Chuck Grassley, who, as the Finance Committee's ranking Republican, will play an influential - perhaps crucial - role in next year's debate. Mr. Grassley has quite correctly complained that the current budget "does nothing about entitlements," and that Democrats see entitlement reform as "a matter for another day." But he has actively grown the most broken entitlement, Medicare, by driving the prescription drug benefit expansion in 2003. In just five short years, the unfunded liability for that single program has ballooned by more than the entire unfunded liability for Social Security. Since then Mr. Grassley has tried several times, unsuccessfully, to add further costs to the broken Medicare system. In 2006, for instance, he championed the elimination of the program's late-enrollment penalty, a rule change that would've cost $1.7 billion.

Medicare is not the only government health-care program which the senator has fought to expand. In the wake of Hurricane Katrina, Mr. Grassley joined with Democratic Sen. Max Baucus to sponsor the 2005 "Emergency Health Care Relief Act," which would have funneled an additional $9 billion into Medicaid. Ostensibly, the bill was intended to provide relief to disaster victims. But the effect would have simply been to expand the number of Americans who depend on taxpayer-funded health insurance.

A better predictor of Mr. Grassley's future behavior in next year's health-care fight may be who he sided with in last year's battle to dramatically expand government-run heath care. He opposed President Bush and supported Sen. Hillary Clinton's politically motivated, multibillion dollar expansion of the State Children's Health Insurance Program, which would have pushed more than two million children into the government health-care system. The plan, which failed thanks to a presidential veto and the resistance of a brave minority in the House, was to have been financed by a cigarette tax, thus tying the health of American children to the purchase of cigarettes. Indeed, Mr. Grassley's approach to health-care policy often seems to follow Mrs. Clinton's lead. Like the former first lady, the ranking Republican on the Senate committee with primary jurisdiction over health policy has endorsed a health-care plan with an individual mandate to purchase health insurance.

This endorsement comes in spite of clear evidence that individual mandates, besides violating an individual's right to choose, actually drive up health-care costs. In Massachusetts, which recently adopted a mandate of its own, skyrocketing cost overruns are currently projected at around $2 billion. The average price of a premium in the Bay State is nearly double what was predicted. And developing minimum benefit requirements - as mandates must do - merely creates a giant giveaway to health-care lobbyists, all while limiting the health-care choices of those covered. In practice, mandates force individuals to purchase coverage they may not need and drive up costs.

The plan Mr. Grassley advocates, S. 334 (legislation originally proposed by Oregon Democratic Sen. Ron Wyden), would create even greater chaos and upheaval in America's health-care system than Mrs. Clinton's current proposal. It would force the majority of Americans who are already covered to give up their current, employer-provided plans. Unfortunately, Mr. Grassley is not alone. Six other Republican senators - Mike Enzi (Wyoming), Bob Bennett (Utah), Judd Gregg (New Hampshire), Norm Coleman (Minnesota), Lamar Alexander (Tennessee) and Mike Crapo (Idaho) - have either introduced or co-sponsored bills that require mandates. These Republican plans feature even more stringent insurance demands for individuals than the one proposed by Barack Obama, who (at least for now) would only mandate insurance for children.

I believe the American people will reward innovative, principled leadership on health care. A rational, conservative solution to rising health-care costs gets the government and other third parties out of our health-care business. Both our families and the GOP can win by expanding Health Savings Accounts, by allowing people to buy insurance across state lines, by doing away with tax policies that encourage third-party payment systems, and by embracing health-care price disclosure.

I have always argued that when we act like us, we win. We proved that in 1994. And when we act like them, we lose. Republicans proved that in 2006. Which GOP will show up on health-care reform is yet to be seen.

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Australia: Young doctors misused in public hospitals

JUNIOR doctors say they are being forced to work in high-stress senior positions, claiming it is putting patients' lives in danger in South Australia. They say they are being left in charge of life-threatening cases like heart attacks because senior doctors are leaving the state for better pay and conditions. Young doctors have entered the fray over the industrial dispute with the State Government, warning patients will be at "immediate risk" if conditions are not improved. A letter signed by more than 300 trainee doctors was sent to the Government this week calling for the urgent resolution of issues, including:

REMUNERATION that reflects their responsibilities, and increased base pay for junior doctors to address issues of attraction and retention.

BETTER professional development allowances to reflect increased training costs.

MINIMUM staffing levels sufficient to allow attendance at conferences and professional development courses.

FAMILY friendly provisions.

The letter said the exodus of doctors due to "poor pay and lack of professional development support" was compromising patient safety. "South Australia is presently unable to provide suitable levels of consultant supervision to junior staff," said the letter to Premier Mike Rann, Industrial Relations Minister Michael Wright and Health Minister John Hill. "This has compromised both our training as junior doctors and the care of public hospital patients."

SA Trainee Doctor spokeswoman Dr Jemma Anderson said existing pay structures did not reflect the increasing demands on junior doctors. "For too long, it has become the norm that trainee doctors work horrendous hours with increasingly limited supervision and teaching," she said. "In SA public hospitals right now, there are doctors only a few months out of their internship working in very senior roles. "If you had a heart attack in one of these hospitals, that junior doctor could be the one leading the resuscitation team to revive you. "This is dangerous for patients and puts trainee doctors under huge stress. "You don't get 300 doctors signing a letter like this unless something is very, very wrong with the system - it's a system on the edge of collapse."

Mr Hill, who is overseas, said in a statement the Government's $260 million offer would make SA junior doctors among the highest paid in the nation. "Junior doctors will receive an up to 17 per cent increase over the life of the agreement," he said. "For medical practitioners in training, their base salary will be the second highest in the nation, after Queensland." He released figures showing a step four medical practitioner in training would go from $68,964 a year base salary to $80,977 by the end of the proposed agreement, plus $10,000 annually for professional development.

Mr Hill acknowledged junior doctors needed supervision and the Health Department's chief medical officer was mentoring them. "The State Government is committed to training and retaining young doctors in the SA health system," he said. "They are the future of our system and we want to keep them in SA."

But Dr Anderson said while the increase was welcome, doctors were not being paid for the level of the work they were actually performing. The South Australian Salaried Medical Officers Association and the Government will meet in the Industrial Relations Commission again on Friday. SASMOA senior industrial officer Andrew Murray said it was waiting on a response from the Government to questions about its new pay offer.

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