Watching ObamaCare topple across the fruited plain like Saddam’s statue in Baghdad is glorious to behold, I think we all agree.
But is there something to put in its place? We’re starting to see some options:
What Republicans can and should do is offer the public something better. Now is the time to advance a conservative reform that can solve the serious, discrete problems of the health-care system in place before ObamaCare, but without needlessly upending people’s arrangements or threatening what works in American medicine. That the Democrats are now making things worse doesn’t mean the public wants to keep that prior system, or that Republicans should.
The biggest Republican misconception about health care is that the system before ObamaCare was a free-market paradise. On the contrary: It has consisted chiefly of massive and inefficient entitlements that threaten to bankrupt the nation; the lopsided tax treatment of employer-provided coverage that creates incentives for waste and overspending; and an underdeveloped individual market struggling to fill the gaps.
Exploding health-care costs and millions left needlessly uninsured are a result of misguided federal policies. Solutions require targeted reforms to those policies.
The first step of a plan to replace ObamaCare should be a flat and universal tax benefit for coverage. Today’s tax exclusion for employer-provided health coverage should be capped so that people would not get a bigger tax break by buying more extensive and expensive insurance. The result would be to make employees more cost-conscious; and competition for their favor would make insurance cheaper.
That tax break would also be available—ideally as a refundable credit sufficient at least for the purchase of catastrophic coverage—to people who do not have access to employer coverage. This would enable people who now choose not to buy insurance to get catastrophic coverage with no premium costs. It also would give those who want more-comprehensive coverage in the individual market the same advantage that people with employer plans get.
Medicaid could be converted into a means-based addition to that credit, allowing the poor to buy into the same insurance market as more affluent people—and so give them access to better health care than they can get now.
All those with continuous coverage, which everyone could afford thanks to the new tax treatment, would be protected from price spikes or plan cancellations if they got sick. This guarantee would provide a strong incentive to buy coverage, without the coercion of the individual mandate. People who have pre-existing conditions when the new rules take effect would be able to buy coverage through subsidized, high-risk pools.
By making at least catastrophic coverage available to all, and by giving people such incentives to obtain it, this approach could cover more people than ObamaCare was ever projected to reach, and at a significantly lower cost.
I have a bedrock aversion to using the tax code for social policy—my version of a 1040 would be a post card—but I salute everything else. The big, big, big, big difference between this and all Democrat notions is individual responsibility. ObamaCare is all about mandates and the government’s unimpeachable determination on what passes for coverage. (I still can’t get over that part—who is Obama to tell you that your plan is inadequate? Go to hell! … Sir.) This model allows individual Americans to pick from a broad range of coverages, using supply and demand to hold prices as low as possible.
I’m serious when I say that’s a big If in today’s America. Do we still have it in us to make our own choices? That’s been debatable for a while, and our decision to allow ourselves to be folded into the bosom of Big Government erodes what faith I have in even our desire to decide our fates for ourselves.
Many countries have socialized medicine, just as many have strict gun control, limits on free speech, and other manifestations of federal control. Some of them are lovely countries, delightful to visit. But do we want to live there? I love America’s “exceptionalism”, it’s treatment of its citizens as sovereigns jointly working together. I grant you that that’s an outdated notion, at least two centuries past its heyday, but a boy can dream.