HEALTH CARE/Joan Retsinas

Cynical, or Clueless, or Ironic?

A question for our times: Is the modern-day Republican party, that of the Sarah Palin-Rush Limbaugh-Glenn Beck triumvirate, cynical? Or clueless? Or have they honed irony to a delicious pitch, much like a Coen brothers’ film?

To the amazement of everybody except the tea-dumpers, the Republicans recently met, in Hawaii, to declaim health reform. Hawaii not only boasts magnificent beaches, glorious sunsets, and tropical drinks stronger than tea. It boasts mandated health insurance, forced upon a beleaguered citizenry by a Big Brother state. The Republicans had breached the lion’s den of Government Intrusion, and emerged unscathed. Indeed, as they declaimed and frolicked and declaimed, they didn’t notice that they were in that dreaded land.

Hawaii plunked its governmental hand onto the free market 35 years ago, when the number of people without insurance had reached what seemed an unacceptably high 30% (then, the highest in the nation — today we’ve grown to accept high percentages of uninsured).

The Hawaiian basics have held strong for more than 3 decades.

Hawaii mandated that all employers except solo entrepreneurs provide health insurance to all employees who work at least 20 hours a week. Predictably, this has skewed employers’ enthusiasm for hiring part-time workers, and has made 40-hour-a-week workers more attractive than 30-hour-a-week ones. But there has been no exodus from Hawaii. And employers have accepted the need to insure workers. In contrast, on the mainland, employers have been dropping coverage.

Hawaii set ground-rules for insurers. The state regulates benefits packages — just as the US government regulates policies marketed to federal employees, including members of Congress. For the laissez-faire enthusiasts frolicking poolside, this government intrusion into the marketplace is anathema — one more reason the British jettisoned tea into Boston Harbor. In their conservative nirvana the Tea-Partiers would scuttle Medicare (lots of ground-rules there). They would open the gates to competition, giving a green light to all the Insurers ’R Us waiting to market their high-deductible, low-cap, multiple exclusion policies. The consumer would be free to choose to be insured or not, just as the Republican partiers could choose the hotels with the best beaches over the student hostels far inland.

In 1974, Hawaii was even more governmentally intrusive, or audacious, depending upon your perspective. The state ruled on premiums. The state decreed that a 50/50 employer/employee split was fair. For low-income workers, the state imposed a 1.5% rule: a worker need pay only 1.5% of gross income for an annual premium; above that, the employer would pick up the tab. Today we mainlanders have grown accustomed to the dilemma of low-wage workers who can’t afford their share of their workplace policies. The workers decline the coverage; sometimes families go onto a state Medicaid program.

If the Partiers had taken a break from declaiming and frolicking, they might have asked the waiters who were serving them, the chambermaids who were cleaning their rooms, and the retailers who were selling them trinkets whether they wanted to scuttle their government-imposed health insurance system and be uninsured, like their counterparts on the mainland.

Soon after Hawaii passed its legislation, the state’s uninsured rate plummeted to 5%. Today it hovers at 10%; a few other states have lower rates, thanks to their aggressive Medicaid programs.

Next year the Republicans should convene in Texas, where 25% of the population is free to be uninsured, as well as free to be sick.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, April 1, 2010