Newt Gingrich’s new 21st Century Contract For America would give seniors the choice of opting out of the Medicare program and buying health insurance coverage in the private market. The former House speaker unveiled the plan in Iowa this afternoon, where he mocked “liberals” for claiming that seniors would be confused by too many choices and compared the purchase of health insurance to shopping at Walmart. “You know there are 250,000 items in a Walmart,” he said. “Maybe you don’t want to go to all the aisles.” Watch it:

Far from a new idea, Gingrich’s proposal is very similar to one he himself considered as speaker and Sens. John Breaux (D-LA) and Bill Frist (R-TN) offered in 1999 and then again in 2001. The idea is to replace the current Medicare program with competing health plans, while maintaining the CMS-sponsored Medicare fee-for-service coverage as an option. Seniors would receive “premium support” that would either be pegged to some economic indicator (like inflation) or compiled through the percentage of actual plan bids for a comprehensive set of benefits. The beneficiary would pay the difference between the the government’s contribution and the cost of the actual plan.

Analysts at the time argued that the proposal would lead to severe adverse selection for seniors who remain in traditional Medicare — increasing their premiums — and would be unlikely to produce significant savings. Henry Aaron — who developed the premium support concept with Robert Reischauer in 1995 — has since walked away from the plan, arguing that the Affordable Care Act may do a better job of lowering costs.

Furthermore, the concern about seniors being overwhelmed with too much choice is a real one, partly because buying health insurance is nothing like shopping at a Walmart. It’s nothing like buying an iPod or a desk lamp. It’s ultimately about extending life and delaying death and asking anyone — particularly older Americans — to bare the brunt of making those decisions when they know so little about the complexities of medicine and insurance policies is not only fool-hearted but also fairly cruel.

If anything, choices have to be very well regulated and few. Surveys conducted by the Massachusetts Connector — that state’s exchange — revealed that even once insurance policies are standardized (so they would be comparing apples to apples), consumers still feel that too much choice is “confusing” and “overwhelming.” “Participants expressed a desire a for manageable numbers of plans (e.g. three to four) offered by four to six carriers. In addition, consumers expressed difficulty making plan comparisons under the existing model,” Massachusetts found. “Instead, consumers preferred for information to be presented in a simple and standardized format that clearly distinguished between different benefit design options.”

Just when you thought the nationwide crackdown on undocumented immigrants couldn’t get any more brutal, the Huffington Post reports that pregnant women in Arizona and Tennessee were detained and forced to give birth while shackled to their hospital beds because they couldn’t produce identification.

The shackling of female inmates when they go into labor has been a roundly condemned practice in prisons, but local authorities are now extending that humiliation to non-violent immigrant women whose only crime was being stopped by police without a valid license:

“When I was in bed, I was begging the sheriff, ‘Please let me free — at least one hand,’ and he said, no, he didn’t want to,” Juana Villegas said in an interview with a local Nashville television station. She was describing the experience of being shackled to her hospital bed as she went into labor. Villegas gave birth in the sheriff’s custody, after she was stopped by local police while driving without a valid license.[...]

Like Villegas, Alma Chacon, and Miriam Mendiola-Martinez gave birth in the United States shackled to their hospital beds, without their husbands, and in the presence of a prison guard. They also were not violent criminals, but rather, they were all undocumented and charged with an immigration-related offense in Sheriff Arpaio’s jurisdiction of Maricopa County, Arizona.

What’s more, Villegas’s lawyer notes that driving without a license is usually handled with a simple citation, not an arrest, leading them to believe the women were only detained because they looked like immigrants.

The three women report shockingly inhumane treatment by police officers. One woman’s newborn son was taken from her within 48 hours of his birth and given to a family member. Local authorities refused to let Juana Villegas use a breast pump the hospital gave her, causing her to be in “great pain.” Alma Chacon says she was not allowed to nurse or hold her baby until she was released from immigration custody almost 70 days after she gave birth.

Pregnant undocumented immigrants are treated even worse than prosecuted criminals, who can be released on bond before they gave birth if they are charged with nonviolent crimes that don’t include the sin of being undocumented.

In 2007, the Bureau of Prisons instituted an anti-shackling policy in federal correctional facilities, but “state correctional facilities are still free to shackle inmates before, during and after child delivery if they see fit.” In 36 states, it’s legal for local authorities to handcuff women to their hospital beds if they are being held for immigration-related charges classified as “criminal offenses.” Those women can also be denied the right to have a family member in the birthing room, or to hold their newborns for longer than 24 hours.

According to a spokeswoman for Immigration and Customs Enforcement, “it is against ICE policy to use restraints in medical situations, absent extraordinary circumstances.” But critics note that ICE refuses to enforce the policy or train local authorities to respect it. “They’re very happy to wash their hands of things, and say, ‘That happened under local authority, not our authority,’” says Michelle Brané, director of the Detention and Asylum program at the Women’s Refugee Commission.

As ThinkProgress previously reported, Vermont Gov. Peter Shumlin (D) made history earlier this year when he signed into law legislation that would make his state the first state to lay the groundwork for a single payer health care system. In order to enact this system, the state needs a waiver from the federal health care law, which it will be able to obtain in 2017. Rep. Peter Welch (D-VT) has introduced legislation to move the waiver date up to 2014, an idea President Obama has endorsed.

Now, another governor is looking to take advantage of flexibility in Obama’s health care law in order to establish a single payer system. Gov. Brian Schweitzer (D-MT) announced yesterday that he will be seeking a waiver to set up his own universal health care system in his state modeled after the single payer Canadian health care system that began in the province of Saskatchewan:

Gov. Brian Schweitzer said Wednesday he will ask the U.S. government to let Montana set up its own universal health care program, taking his rhetorical fight over health care to another level. [...] The popular second-term Democrat would like to create a state-run system that borrows from the program used in Saskatchewan. He said the Canadian province controls cost by negotiating drug prices and limiting non-emergency procedures such as MRIs.

Local news station KRTV covered Schweitzer’s bid for a new universal health care system for his state. Schweitzer said that under his ideal system patients can still buy private insurance if they want to, but that it’ll be a “lonely place over there at Blue Cross Blue Shield” due to the superior public health insurance he plans to provide. Watch it:

Schweitzer’s announcement to seek a waiver and design his own system was met with curiosity by GOP state Sen. Jason Priest, who responded, “I don’t want to reject it before I see the details. I am just glad he is thinking about it.”

Newt Gingrich releases his new 21st Century Contract with America today in Iowa. His website describes the proposal as “larger and more complex…than any presidential campaign has undertaken in modern times” but “the minimum necessary to mobilize the American people, change the entrenched elites and their system, and get America back on the right track.” The document is meant to recall the former speaker’s 1994 Contract with America, but a closer reading of the new proposals suggests that the Gingrich of today may not necessarily agree with the Gingrich of yesteryear.

For instance, the first proposal promises to “Repeal Obamacare and pass a replacement that saves lives and money by empowering patients and doctors, not bureaucrats and politicians.” The contract goes after the law’s requirement to purchase health insurance coverage beginning in 2014, calling it “unconstitutional.” It also criticizes the law’s efforts to help lower-income Americans access affordable coverage. “[O]nce the government mandates such expensive insurance, the government becomes responsible for its costs. It has to adopt expensive subsidies to help people pay for the expensive plans that it is requiring,” it reads.

Instead, Gingrich offers to replace the law with a consumer-driven solution:

This system will assure healthcare for all with no individual mandate or employer mandate of any kind. This alternative to Obamacare begins with patient power and localism and the many common sense ideas developed over the past eight years at the Center for Health Transformation.

Over the next year, I look forward to discussing solutions for a pro-market replacement for Obamacare that puts top priority on empowering patients, focusing on the doctor patient relationship, using the best new science to save lives and save money.

But as Mitt Romney recalled yesterday during a radio interview with Sean Hannity, Gingrich has previously supported the very mandate his contract wants to repeal.

Gingrich advocated for coverage mandates in the mid-2000s, when he partnered with then-Sen. Hillary Clinton (D-NY) “to promote a centrist solution to fixing the nation’s health care system” and wrote in his 2005 book, Winning The Future, that “a 21st Century Intelligent System requires everyone to participate in the insurance system.” He even endorsed Medicaid expansion and subsidizing coverage for lower income Americans. “People whose income is too low should receive Medicaid vouchers and tax credits to buy insurance,” he continued. “Large risk pools (association health plans are one model) should be established so low-income people can buy insurance as inexpensively as large corporations. ”

Mitt Romney described the individual health mandate as a “conservative idea” yesterday afternoon on Sean Hannity’s radio show, just as the federal government asked the Supreme Court to review the constitutionality of the provision in President Obama’s Affordable Care Act.

“The idea for a health care plan [in Massachusetts] was not mine alone,” Romney explained. “The Heritage Foundation — a great conservative think tank — helped on that. I’m told Newt Gingrich, one of the very first people who came up with the idea of an individual mandate, did that years and years ago”:

ROMNEY: It was seen as a conservative idea to say, you know what? People have a responsibility for caring for themselves if they can. We’ll help people who can’t care for themselves, but if you can care for yourself, you gotta take care of yourself and pay your own bills.

Listen:

In 2006, the Heritage Foundation — which attended the signing ceremony for the law — described Romney’s mandate as “not an unreasonable position, and one that is clearly consistent with conservative values,” claiming that it would reduce “the total cost to taxpayers” by taking people out of the “uncompensated care pool.”

Gingrich also embraced the “ultimate conservative idea,” writing in a 2007 Des Moines Register op-ed, “Personal responsibility extends to the purchase of health insurance. Citizens should not be able to cheat their neighbors by not buying insurance, particularly when they can afford it, and expect others to pay for their care when they need it.” An “individual mandate,” he added, should be applied “when the larger health-care system has been fundamentally changed.”

During his health care address on Tuesday, House Budget Chairman Paul Ryan (R-WI) explained his overarching health care philosophy this way: “Simply put, badly designed government policies are to blame for much of what is wrong with health care today, and the solution is clear: We need to transition from the open-ended, defined-benefit approach of the past…to market-oriented, defined-contribution reforms that promote choice and competition.”

The existing “defined benefit” approach is not without its problems, but it guarantees that Americans receive health care benefits and spreads the economic risks across rich and poor, healthy and sick. A defined contribution is a lump sum of money that does not come with any promises that it will be sufficient for individuals and families to purchase the health care coverage they need in old age. It also asks the individual to shoulder more of the risk of insurance.

As health care analyst Bob Laszewski put it yesterday, in Paul Ryan’s premium support dream world — in which future retirees are handed a lump sum (that’s the defined contribution) to go out and purchase insurance through an exchange of pre-approved private plans — “neither insurers nor health care providers would have any of the risk, and therefore responsibility, for keeping costs under control. The entire burden for the adequacy of these premium support payments would be with the beneficiary. If health care costs rose faster than these premium supports, tied to these indexes that have always trailed health care inflation, too bad for the beneficiary. Any excess cost is borne by the individual”:

Ryan and his colleagues would argue that this is just what we need to create—a market so robust we can finally begin to control costs. Beneficiaries struggling to make their health care dollars stretch would seek out those health insurance plans that really did control costs….As I have said before, after more than 20 years of defined contribution health insurance experience in the market there is no evidence this will occur. The Ryan school of health care thought argues that, “By putting the power into the hands of individuals, we can let competition work in health care just as it does everywhere else.”

I am continually amazed at those who argue the health care market can work, as Ryan put it today, “as it does everywhere else.” They are right that the health care system is too much driven by third-party pay and its beneficiaries have historically had too little incentive to be prudent buyers. But the health care market is also a one driven by complex science, major and legitimate philosophical differences about treatment choices, and enormous supply-side powers.

Indeed, Austin Frakt has pointed out repeatedly that if individuals with higher cost sharing really do use less care, then beneficiaries in employer-sponsored insurance (who receives a 40 percent tax subsidy, on average) should spend less than Medicare enrollees — who receive a far higher government subsidy. But data from the Kaiser Family Foundation suggest that this just isn’t the case.

“In short, grandma, or you or me for that matter, is no match for the American health care system,” Laszewski concludes. “[H]ospitals, doctors, drug companies, and insurers have the potential to affect the cost of health care far more than your grandmother will ever have.” And without taking steps to controlling their costs and changing the way they’re reimbursed, Ryan’s plan is just what it sounds like: a major cost-shift.