If Rip Van Winkle fell asleep during the last major effort to reform the health care system and woke up today, he wouldn’t be able to gauge how long he’d been out. While he slept, opponents of comprehensive health care reform reloaded their gun, but they loaded the clip with the same bullets.

During the early 1990s, the Heritage Foundation issued a series of primers characterizing Clinton’s reforms as a “top down, command-and-control system” that would “meticulously govern virtually every aspect of the delivery and the financing of health care services for the American people.” A simple copy-paste job fourteen years later and Heritage is now warning that a national health board and a new public health plan — as proposed by Baucus, Obama, and Daschle — would “cancel private coverage and care“:

A new public agency–variously described as an institute, board, or council–that would make key recommendations regarding the kinds of medical technologies, treatments, drugs, and procedures that would be officially deemed “effective” …would constitute an unprecedented level of government regulation and control over the delivery of health care….The creation of a new public plan would result in millions of Americans losing their employment-based coverage coupled with a massive expansion of government coverage and financial control.

The Federal Health Board, designed to set “evidence-based standards for benefits and quality for federal programs,” would, in fact, establish independent “control over the delivery of health care.” But this reform would result in less government control, not more. Congress’ role would be limited. In the same way that it doesn’t regulate monetary policy (that’s up to the Federal Reserve) or flight safety (that authority is vested in the FAA), Congress would task health care decisions to a broad spectrum of health-care participants who would “make decisions informed by expertise and experience, much of it private sector experience.” “We would try to streamline the tremendous bureaucracy that exists today… if you think our banking system today is reasonably regulated, why not try the same type of model for our health-care system?” asks the incoming Health and Human Services Secretary.

Heritage’s claim that allowing private companies to compete with a new public program would choke private insurers, raises its own questions. The Foundation claims that “genuine market competition is not envisioned in any of these proposals” since “the government would not only be a participant in the competition but would also be setting the rules for the competition”:

With the government plan, taxpayers would presumably absorb all of the risks, losses, and liabilities of such an enterprise, while private health plans would absorb their own risks, losses, and liabilities. Consequently, from the beginning, such a competition could not possibly be fair in any meaningful sense.

Currently, insurer and hospital markets are increasingly dominated by large insurers and provider systems. These private insurers do not use their market power to “drive hard bargains with providers” and have no need to bargain with providers.

Introducing an efficient public option would force private plans to offer better services through higher levels of efficiency and force the public plan to maintain reasonable physician and hospital reimbursement rates (otherwise enrollees would exit to private plans.) Even if private plans charged higher premiums, most would still survive because they are typically more responsive to consumer demands for choice. As Linda Blumberg, a Principal Research Associate at the Urban Institute, explains, “some people are going to be very willing to pay more money to stay in a private plan if they perceive that plan as being higher quality, giving them a boarder network or richer benefit packages.”

Still, Heritage’s concern about fair competition is duly noted. The playing field has to be leveled. Baucus has explained that under his plan, the “public option must offer benefits similar to private plans in the Exchange.” Others have proposed a “two-fold structure” within which a public insurance plan “would be offered in the mix of competitive options and then there would be some kind of oversight board that would be in charge of overseeing that competition that would be separate from it.”

After inexplicably describing the September bailout of Wall Street as a package that would “help those who are concerned about health care reform,” Gov. Sarah Palin (R-AK) yesterday unveiled a hodgepodge of different health care initiatives no more effective in tackling the state’s higher-than average health care costs and uninsured rate.

At best, Palin’s proposals are small steps to a larger reform effort. At worst they’re a wholly inadequate set of ‘pilot programs’ designed to bolster Palin’s health care credentials without accomplishing much at all.

With efforts like these, who needs access to care?:

With amazing outdoor activities in fresh clean air and consumption of healthy clean protein in the form of wild game and Alaska’s sea food. We got berries, we’ve got Alaskan-grown produce and those things need to be promoted.

Listen:

Outdoor activity is not a “silver bullet” to increasing health outcomes, Palin confessed. Other “fiscally responsible” approaches must be considered:

- Greater deregulation: Palin had previously led an effort to repeal Certificate of Need laws, (CON) — “a regulatory process that requires certain health care providers to obtain state approval before offering certain new or expanded service.” Despite evidence that repealing CON laws would drive-up health care costs, Palin claimed that loosening CON laws would “invite more competition in our larger market to provide health care.”

- Purchasing insurance across state lines: In a throw-back to Sen. John McCain’s (R-AZ) health care plan, Palin promised to “support efforts on a national level for allowance of residents in one state to look for insurance in other states, again all in the name of competition, resulting, ideally, in more affordability, in addition to supporting other national initiatives that newly election administration coming into office can provide opportunity for.”

- Web-MD Alaska: Called, ‘Live Well Alaska,’ this website “pulls together all the best advises for healthy eating and exercise and quitting smoking and it also incentivizes healthy life styles with Alaskan stories and health challenges..” “Alaskans are unfortunately becoming dangerously unhealthy due to poor diet or little or no exercise…each of us must take personal responsibility for our level of health, those things we can control, and not look to government to make us healthy…’Live Well Alaska’ will help.”

- Alaska Health Care Commission: “The purpose of this is to provide recommendations for and foster developments of the state wide plan to address the quality, accessibility, and availability, of health care here in Alaska and this is the result of our Health Care Council’s recommendations to do so.”

- Boost funding to Denali Kid Care (SCHIP): Palin proposed increasing eligibility from 175% to 200% of the Federal Poverty Level to cover an additional 1,300 kids. “It’s going to be good for more children to be on the rolls to have the opportunity for the coverage,” Palin announced. When questioned why she previously opposed such an expansion, Palin explained that she appointed “new commissioners” with a “new vision.”

What’s missing from Palin’s plan is broad access to affordable coverage or cost-containment measures to make reform possible. Let’s hope her Health Care Commission, the members of which have yet to be appointed, offers a more comprehensive proposal.