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10/15/15

An early lead in the health wonk primary for Jeb Bush

Former Florida governor Jeb Bush released his 2016 health plan on Tuesday, including a 10-page background paper that fleshed out a shorter summary outline. The good news is that it’s more serious and detailed than the handful of plans offered by his rivals for the Republican presidential nomination. The better news is that it tries to suggest several steps beyond the standard “repeal and replace” orthodoxy regarding Obamacare.

The disappointment involves a few predictable overstatements, incomplete gestures, and dodges. By the standards of past and present Republican presidential campaign plans thus far, his “Conservative Plan for 21st Century Health” puts Bush in the lead in the health policy wonk primary, without either surrendering the fight to overturn Obamacare or risking political liabilities within Republican ranks with more radical proposals.

Republican presidential candidate Jeb Bush listens as Matt Albuquerque, owner of Next Step Bionics & Prosthetics, explains how the technology in the prosthetic leg of Sean Kiernan works at the business in Manchester, New Hampshire October 14, 2015. REUTERS/Mary Schwalm .

Republican presidential candidate Jeb Bush listens as Matt Albuquerque, owner of Next Step Bionics & Prosthetics, explains how the technology in the prosthetic leg of Sean Kiernan works at the business in Manchester, New Hampshire October 14, 2015. REUTERS/Mary Schwalm .

First, most of the usual mainstream conservative boxes are checked.

  • Refundable tax credits for individuals without offers of employer-based coverage.
  • A move away from income-based redistribution of health care subsidies.
  • Avoiding blowing up current arrangements for employer-based insurance, even while offering new tax relief for individuals who buy insurance on their own.
  • Elimination of Washington’s mandates for coverage that employers must offer, individuals must buy, and insurers must cover.
  • Delegation to state governments for the harder work of Medicaid reform and health care deregulation.
  • Tilting tax advantages toward larger and less restrictive health savings accounts.
  • A short bow to the Religious Right in terms of protecting innocent human life (apparently preserving the death penalty for older criminals?) and related matters of conscience in practicing medicine.
  • And, of course, sufficient denunciations of the failures and horrors of Obamacare.

Second, the Bush plan tries to set a broader theme upfront. The former governor wants to project his campaign as forward looking and 21st Century, while he criticizes current health policies largely as remnants of a failed past. The health care future is not now, but it could arrive right after the next round of elections.

Hence, Bush extends several rhetorical embraces of the potential wonders ahead from less-regulated development of the next technological innovations in health care. If only the federal government would … just butt out and leave daring entrepreneurs alone.

This stance also reinforces the standard Republican sweet tooth for almost any new product in health care that can be labeled innovative and include a private-sector label. Taxpayer subsidies for those products are always welcomed; it’s just those darn regulations and price restrictions that get in the way of getting them quicker.

Hence, the plan includes a revived embrace of enhanced funding for the National Institutes of Health, albeit without much of a distinct action plan beyond putting more money in its budget to chase after the most popular disease targets.

The Bush plan’s section on pro-innovation FDA reform is more thoughtful. It outlines a number of steps to expand the market for the data needed to monitor safety and effectiveness, while helping more drugs and products to be launched initially. On the other hand, a handful of phrases proposing “private sector leadership” of health information technology development standards look more like shallow placeholders than a new direction forward. They might hint at a better approach, but fail to flesh it out what work differently in the future.

The Bush plan gains higher ground by signaling how its health policies can be more effective. It would focusing more on incentivizing competition to producing measurable outcomes and results, and much less on empty rounds of micromanaging how to achieve them.  That’s particularly notable in the former governor’s approach to facilitating state-driven reform of Medicaid reform and retargeting other types of assistance to vulnerable populations. The political case for greater freedom to try new approaches in health care is strengthened greatly when it is combined with more accompanying accountability for delivering better on its promised results.

The Bush proposals also suggest a greater fluency and understanding of the importance of enhanced transparency, data sharing, and information development in health care. For example, it urges wider access for responsible commercial researchers to de-identified Medicare and Medicaid claims data.

The plan also hopes to amplify the next wave of more portable private sector insurance coverage, by highlighting the potential of private exchanges and reversing recent regulatory barriers to employers’ defined contributions to individual market policies.

Those are the most significant bright spots of the Bush blueprint. No big surprises. A little nuanced pushing of the envelope in several places.

Most denizens of Republican health policy wonkdom were happy to see their ideas recognized and recycled. We’ll take a look at some lesser blemishes, difficult straddles, and lingering challenges ahead, in part 2 next time.



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