Four Republicans -- Senators Tom Coburn of Oklahoma and Richard Burr of North Carolina along with Congressmen Paul Ryan of Wisconsin and Devin Nunes of California -- have fired the first salvo in the great health care reform debate.
They've introduced the Patients' Choice Act. Now, although we have a pretty good idea of what Democrats have in mind, we await crystallization of their ideas into legislation.
The difference of approach of the two parties on health care rides on the same basic question that divides the country and the parties on everything else. Are the problems we're facing today the result of too much government intervention in our economy and our lives or not enough?
The Patients' Choice Act reflects Republican thinking that health care costs are out of control and, as result, not affordable for many, because of too much government. It allows Americans to take direct control of their health care expenditures by giving families and individuals cash in the form of a tax credit ($5700 and $2300 respectively) to buy insurance and set up a Health Savings Account.
Democrats will take things in the opposite direction. Rather than controlling costs and access through more competition and consumer control, they see it coming from more government and regulation. Mandates on employers to provide insurance, fines if they don't, and using those funds to finance a new subsidized government plan.
And central to cost control are government bureaucrats defining what procedures may be used and determining what physicians will be compensated.
I'd suggest two considerations in assessing whether today's runaway costs and inefficiencies are the result of too much government or not enough.
First, we already have massive government involvement in health care. Practically half of all health care delivered today comes directly from government programs -- mainly those begun in the 1960's. Medicare, Medicaid, and then later the State Children's Health Insurance Program (SCHIP).
Only 35 percent of health care is paid for through private insurance. Some 87 percent of it is paid for by third parties -- either government or employers. In 1960, 60 percent of Americans' health care expenditures were out of their own pocket. Today it is 12 percent.
So massive growth in health care spending and cost escalation correlates directly with increasing government involvement in this marketplace and decreasing consumer control over their own expenditures. Does this tell you something?