Herman Cain laid out his health care vision during an address to the Congressional Health Caucus this afternoon, and it boiled down to this: in order to protect the best health care system in the world, we must repeal the Affordable Care Act, deregulate the insurance industry, and let the free market find insurance coverage for everyone. During a question an answer session with members of Congress, Cain applied his easy-to-understand health care solution to Medicare and suggested that that he would lower spending in the federal program by shifting the responsibility of providing health care to seniors to the states — which are already struggling with growing health care costs in the Medicaid program:

CAIN: Much of the over-regulatory burden that’s imposed by Medicare is driven by the fact that the bureaucrats don’t trust states and hospitals, I do. I would rather error on the side of trusting the states, and maybe five of them won’t get it right, but that the other 45 are going to get it right and we all will benefit. So we have to restructure how Medicare is administered, how the dollars are spent.

Watch it:

It’s unclear if Cain is referring to any specific proposal, although several states have passed “compacts” that would theoretically exempt them from the federal eligibility and benefit rules in the Medicare program and allow them to join other states in establishing their own Medicare rules. Congress would be required to approve these arrangements.

A commenter noted that I was wrong to liken the Domenici/Rivlin “premium support” plan to Rep. Paul Ryan’s (R-WI) privatization scheme and suggested that the two are more different than I let on. That’s probably true for several reasons, as Alice Rivlin herself explained before the Super Committee yesterday:

1) Under Domenici/Rivlin, future enrollees would have an option of staying in the existing fee-for-service Medicare program, while Ryan would force tomorrow’s seniors to choose a private plan from an exchange.

2) The “premium support” that seniors receive to purchase coverage in Domenici/Rivlin will initially be tied to the second highest bid plan or fee-for-service, whichever is lower, and grow at the rate of GDP+1 percent. Ryan’s credit would remain independent of actual plan bids and would only grow the government contribution at the rate of inflation. Both indicators fail to keep up with health care spending, so seniors would have to pay the difference between the support and the actual cost of the plan out of pocket. But unlike Ryan, Domenici/Rivlin exempt lower income beneficiaries and dual eligibles are able to use Medicaid funding to pay for Part B premiums.

3) Domenici/Rivlin are likely to go further in regulating the private plans — and what kinds of benefits they can offer — than Ryan.

Domenici/Rivlin do more to protect lower-income beneficiaries from increased costs than Ryan. But ultimately, the plan still has significant shortcomings. Connecting the premium support credits to the second lowest plan in any given geographic area is certainly better than determining the credits independent of the actual bids, but as CBPP’s Edwin Park points out, in some markets, the second lowest plan is cheaper than coverage available through traditional Medicare. Thus, seniors who choose to stay in the fee-for-service plan would be responsible for the difference between the amount of the premium credit and the actual cost of the policy. Lower-income residents would receive additional assistance and would not have to pay more for traditional Medicare, the Bipartisan Policy Center’s Joe Minarik told me.

The other major challenge is the assumption that one can create a truly level playing field in which private plans are prevented from cherry-picking the healthiest beneficiaries and leaving sicker applicants to traditional Medicare. Minarik said that regulators can look to FEHBP for guidance, but admitted that we have minimal experience with competition within the elderly population and agreed that the regulatory process will be “challenging.” In that case, private insurers may still be able to attract a healthier population (and thus select against sicker applicants) by varying benefits by scope — ratcheting down certain services that sicker beneficiaries rely on like chemotherapy and building up coverage for healthier applicants, like preventive services.

So that, in a nutshell, is the problem: premium support sets us on an untested path of private competition that could do more to shift costs to seniors than limit overall health care spending. It moves the system closer to the Ryan ideal in which future Congresses could cut federal costs by eating away at the premium credit.

A better approach would be to take advantage of the bargaining clout of traditional Medicare and focus on modernizing the system through payment reform and delivery system changes.

Yesterday, the Vermont Legislative Joint Fiscal Office and the Department of Banking, Insurance, Securities and Health Care Administration released a new report estimating the savings the state could experience if it successfully enacts the single payer system it began designing earlier this year.

Using both a low and high estimate, the report concludes that the state would save between $553 million to $1.8 billion by the year 2020 by shifting to a single payer health care system and enacting other reforms along with it. The following chart from the report shows that these savings come from reductions in payer and provider administration, investments, clinical reforms, and fraud reduction:

In May, Gov. Peter Shumlin (D-VT) signed a groundbreaking law that seeks to implement a single payer system. But to enact the system, the state needs a waiver from the Affordable Care Act health reform law. Currently, the federal government will start handing out state waivers in 2017 — three years after Vermont wants to implement its system. Rep. Peter Welch (D-VT) has introduced an amendment that would move the waiver date up to 2014. Sens. Ron Wyden (D-OR) and Scott Brown (R-MA) have introduced a companion bill in the Senate. President Obama has endorsed the idea of moving the waiver date forward.

On Nov. 8, Mississippi voters will vote on Initiative 26, a personhood constitutional amendment that defines a person as “every human being from the moment of fertilization, cloning, or the functional equivalent thereof.” Personhood amendments like this are an extreme invasion of a woman and family’s privacy, not only criminalizing abortion but potentially outlawing common forms of contraception.

While the religious right are standing firmly behind the amendment, not all anti-abortion supporters are thrilled about the this radical overreach. Today on Fox and Friends, Mississippi Gov. Haley Barbour (R) expressed considerable concern over the bill’s ambiguity, noting “a lot of pro-life people have problems with this particular language.” Following up with MSNBC’s Chuck Todd, Barbour reiterated that he believes “life begins at conception” but that he may not vote for the bill because of the “ramifications” it will have on a woman’s reproductive rights and health:

BARBOUR: I believe life begins at conception. Unfortunately, this personhood amendment doesn’t say that. It says life begins at fertilization, or cloning, or the functional equivalent thereof. That ambiguity is striking a lot of pro-life people here as concerning. And I’m talking about people that are very, outspokenly pro-life. [...]

TODD: How are you voting on it?

BARBOUR: Really I haven’t decided. If you would have asked me when this was first proposed, I would’ve said A, the legislature would’ve passed it 100 to 1. And B, I believe life begins at conception and therefore I would be for it. I am concerned about some of the ramifications on in vitro fertilization and [ectopic] pregnancies where pregnancies [occur] outside the uterus and [in] the fallopian tubes. That concerns me, I have to just say it.

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Barbour is correctly concerned about the “profoundly ambiguous” language of the bill. Fertilization can be defined at least four ways, beginning either with the sperm’s penetration of the egg or, as those behind the bill suggest, when the embryo is formed even before its implantation in the uterus. Such a definition could ban the birth control pill, stem cell derivation, and — as Barbour notes — in vitro fertilization procedures for couples trying to have a baby.

But it is important to note that Barbour’s preferred ban from “conception” still subjects women to serious ramifications. Conception is medically defined as the implantation of the embryo. Most women don’t even know that they are pregnant until four to six weeks after this occurs. “Life at conception” rules would be the most radical ban on abortion yet, completely eradicating a woman’s constitutional right to choose.

As Republicans move to outlaw abortion in the states and the GOP’s presidential candidates outdo themselves in opposing the procedure — promising to establish new federal restrictions and sign legislation prohibiting abortion in all circumstances — “Latin America, home to the world’s strictest abortion laws, may hold lessons” for conservatives hoping to ban the practice, Bloomberg’s Flavia Krause-Jackson and Caroline Alexander report.

“A consequence of the laws, whatever the moral arguments, is that Latin American women have more ‘unsafe’ abortions per capita than women in any other region, according to the World Health Organization,” and as a result, an estimated “900 women died in 2008 from unsafe abortions in Central and South America.” In some cases, the laws have stopped doctors from providing life-saving health care services to women:

In Nicaragua, where a complete ban was passed in 2006, psychologist Marta Maria Blandón recounts the case of a married young woman carrying her first child, who sought treatment for acute stomach pains. She died in a hospital bed because doctors, afraid to intervene, ordered more tests when a therapeutic abortion would have saved her life, according to Blandón.

Ipas, an international women’s advocacy group with an office in Managua, estimates that at least 100 women in Nicaragua have died in the past five years as a result of the law because health authorities didn’t perform abortion when atypical pregnancies put the mothers’ lives in danger.

Significantly, Republicans seek to limit access to abortion as they undermine funding for sex education, contraception and health care — what experts consistently identify as the “most effective ways of reducing abortions.” The health care piece is particularly galling, since the GOP would repeal the ACA without any concrete alternative for care to mothers and their newborn children.

Women contemplating an abortion are far less likely to seek one if they can afford health insurance for themselves and their babies, research finds. In fact, according to a report in the New England Journal of Medicine, “the number of abortions in Massachusetts declined by 1.5 percent during the first two years of the new health care program (2007-2009) and the decline was 7.4 percent among teenagers — even though the percentage of non-elderly people receiving coverage went up nearly 6 percent.”