April 3 2012
The Health Reform War Will Come Back
If you thought America was done talking about health reform in 2010, you were wrong.
We do now have ObamaCare, like it or not, but it's not over until the Supreme Court upholds the entire law and Obama is re-elected. If both those things happen, we'll be very limited in what we can do to undo the law.
But both of those things have to happen. The Court will rule first - in late June - and regardless of their ruling, health care will come back into the national spotlight and will be a major issue in the 2012 election. In a press conference on the steps of the Supreme Court last week, I focused my message on the positive: If we can put ObamaCare behind us, either through a Supreme Court ruling or a legislative repeal, we can unite behind real reforms that focus on putting doctors and patients in charge and getting government out so markets can be competitive, and costs can be reduced at their root.
Conservatives should be prepared. If we don't get a real opportunity to replace ObamaCare will market-driven policies, we should at least be ready to present the public with a clear-cut alternative to government-controlled health insurance and health care.
John Cochrane has an excellent overview in today's Wall Street Journal, "What to Do on the Day After ObamaCare."
So, for every person who has ever asked, "What would conservatives do instead??" I recommend this piece to you. And, I offer some Cliffnotes below:
Unlink employment and insurance by giving employer-sponsored and individual insurance the same tax treatment.
Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.
Strip state and federal "minimum coverage requirements," and allow people to buy insurance across state lines.
Remy explains these ideas in his latest video:
Reform Medicaid and Medicare into private voucher or "premium support" models to continue helping people but giving them a little responsibility.
What about Medicare and Medicaid? Two words: premium support. The underlying point of premium support is simple. If insurance costs $5,000 and the government gives an individual a $4,500 voucher, that individual will still feel the correct economic signal to shop for cost-efficient health insurance and health care.
Deregulate hospitals and the medical profession to make the health care market more transparent and competitive.
The number of new doctors is still restricted, thanks to Congress and the American Medical Association. Congress caps the number of residencies, the AMA has fought the expansion of medical schools, state tests make it difficult for foreign doctors to work here, and on and on.
There are hundreds of government impediments to competition. New hospitals? In my home state of Illinois, every new hospital, expansion of an existing facility or major equipment purchase must obtain a "certificate of need" from the Illinois Health Facilities Planning Board. The board does a great job of insulating existing hospitals from competition if they are well connected politically. Imagine the joy United Airlines would feel if Southwest had to get a "certificate of need" before moving in to a new city—or the pleasure Sears would have if Wal-Mart had to do so—and all it took was a small contribution to a well-connected official.
To compare ObamaCare to the status quo and say, "ObamaCare is the liberal option; conservatives want the status quo," is a mischaracterization of the debate. Conservatives want less government intrusion (which is why we oppose ObamaCare). But there are real problems in the health system's status quo, which conservatives should address through deregulation, entitlement reform, increased individual choice in the market, and patient-centered care.