Robert F. Graboyes

Robert F. Graboyes

Robert F. Graboyes is the senior health care adviser at the National Federation of Independent Business (NFIB) in Washington, D.C.

With a huge pen and sharp scissors

Let's start on a positive note: the Senate Finance Committee worked hard to try to make its bill palatable to small business. A number of business-friendly provisions made their way into the Majority Leader's bill. The SHOP health insurance exchanges come to mind; so do insurance market reforms and some opportunities for individual choice in health insurance.

The Senate bill is not the hopelessly unsalvageable House bill. That said, its good points are still greatly overshadowed by its negatives. It will take a lot of work to make the Senate bill acceptable to small business. But since you ask, here's a holiday wish-list:

  • More effort to get costs down without damaging quality of care. Wider coverage is great, but cost-cutting has to be up and running from Day One.
  • Get rid of the public option. This time-wasting afterthought of an idea would wreck private insurance markets and do nothing to bring costs down.
  • Lose the employer mandates. Employer mandates are still job-killers, and exemptions don't change that fact.
  • Reduce the torrent of red-tape that the bill wraps around small business.
  • Stop the erosion of consumer-driven health insurance products like HSAs, HRAs and FSAs.
  • Chuck the accounting tricks so Americans properly compare costs and benefits. A prime example is starting costs in 2010 but delaying reforms till 2014. Another is the now-you-see-it, now-you-don't doc fix.
  • Eliminate the CLASS Act - an enormously expensive new entitlement rising up as Medicare and Medicaid are sinking financially.
  • Consider seriously the impact a rapid swelling of Medicaid will have on states and the taxpayers (including small business) in those states.
  • Add in some real medical liability reform. This issue takes a terrible toll on the doctor-patient relationship, and there's little evidence that our tort system does much to improve health.
  • Do more to permit Medicare to shift out of its rusting fee-for-service reimbursement system that increases costs and diminishes quality.
  • Index taxes (e.g., the high-cost policy excise tax and the Medicare payroll tax increase) to inflation to avoid creating more AMT-like monstrosities.
  • While we're on the Medicare payroll tax expansion, how about if we forget about it altogether? Payroll taxes -- even restricted ones -- diminish the incentive to create jobs. There is also a slippery slope aspect to this tax in that, for the first time, funds collected for Medicare will be diverted to other uses.
  • Stop adding tax inequities that further burden small business. A prime example is the insurer tax that falls mostly on the fully insured market.
  • Give tax parity to those getting insurance through the group and individual markets, and make sure that the self-employed enjoy this parity, as well.

By Robert F. Graboyes  |  November 30, 2009; 3:38 PM ET Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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Comments

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Universal Health Care is a Myth, there is and never has been an efficient or cost effective program ran by any Government.

I say scrap Medicare and Medicaid, use the funds from those programs to buy private insurance for every American Citizen. It would cost less and it would keep the Government out of the Health Care Business.

Posted by: jstanton2 | December 5, 2009 2:00 PM
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Mr. Graboyes solutions take into consideration the insurance companies more than the thousands of Americans dying for the lack of care.

This bill should point us all in the direction of a National Health Care system. Elimination of the middleman and volume buying is the key to cost control here.

Not to mention, in England, the National Health Service is the second largest employer. (the Military is first) We could use the jobs. If we use American manufacturers, priced by bids-the effect on our GNP could be dramatic.

Anyone that thinks the government can't be efficient has never forgotten to pay their taxes or tried to duck the draft.

Posted by: ThePoliticalStraycom | December 5, 2009 12:38 PM
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Mr. Graboyes' "prescription" is excellent. I agree 100% (almost) with his recommendations, especially tort reform and elimination of the "fee for service" lunacy. No health reform will be successful unless the cost and waste are reduced. There is no reason (except greed) spending twice as much as the average of the rich nations.

Posted by: socrates1929 | December 1, 2009 2:26 PM
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