The NFIB's Heath Care Principles: Same Old Medicine; New Bottle

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Just in advance of Christmas, the National Federation of Independent Business introduced last week its "Small Business Principles for Health Care Reform." The timing is fitting, because while the NFIB calls its "principles" a "balance [among] the competing goals of quality care, affordability, and predictability and consumer choice," it is in fact little more than a wish-list of policies, often at cross purposes. Whether they come to pass or not, I suspect, will depend on whether the organization has been bad or good this year.

What does the NFIB intend to lobby for? It would like to see 1) universal coverage that is "to the greatest extent possible" furnished by the 2) private sector yet still somehow 3) affordable. In the NFIB's dreamscape, health care policy would push people away from employer coverage and into 4) individual policies that would be 5) lightly regulated, 6) transparent, and 7) portable. Finally, health care itself should be 8) efficient, 9) "evidence-based" and 10) "realistic", whatever that means. (The principles are here, and the press release is here.)

Who doesn't want some or all of that? Everybody does, which is why the NFIB's scheme could never work, let alone become law in the first place. Even so, according to a statement from NFIB, these principles are "the culmination of more than 20 years of research, coupled with months of meetings with leading health care policy experts from across the country." Should I let that pass without comment?

On the one hand, the NFIB wants coverage for the uninsured, but they'll be damned sure that firms that don't offer coverage won't be on the hook for it. "A health care system built on employer mandates or on play-or-pay taxes is unacceptable," says the NFIB. Who, then, would foot the bill for universal coverage -- which because the NFIB insists the government not provide on its own will certainly be even more expensive? Absent the hand of regulation, how will those with pre-existing conditions find "affordable" insurance, or any insurance at all? Here's a clue: "Any competitive system must guard against adverse selection -- a situation in which some individuals purchase policies only after learning that they are likely to face high medical costs." So: not so much universal as universal-ish.

Essentially this recently unveiled platform, two decades in the making, is what the NFIB has been advocating for (probably about 20) years: a burden placed nearly entirely on the individuals with less government oversight. Since nothing has changed, except for the gloss of pseudo-universality, perhaps a better question than "What does the NFIB stand for now?" might be this: does the NFIB still have the lobbying muscle to pull it off?