During a segment on Morning Joe yesterday, I argued that conservatives should craft a framework for an alternative to ObamaCare.
A conservative alternative would encourage and incentivize people to purchase health insurance voluntarily, without mandates. It would cover people who legitimately cannot provide health care for themselves, while also stressing personal responsibility. And it would help people who want insurance, but couldn’t get it prior to ObamaCare.
Of course, some conservative options have already been floated. For example, Rep. Tom Price (a surgeon, himself) has — on three different occasions — introduced alternative plans to repeal and replace ObamaCare. And writing in the Wall Street Journal yesterday, Ramesh Ponnuru and Yuval Levin argued in favor of reforms like changing the tax code to incentivize coverage, and offering catastrophic coverage options.
The problem isn’t a lack of ideas, but that conservatives have not collectively rallied around a single framework.
To be sure, there are some frequently-heard talking points: Consumers should be allowed purchasing across state lines (to encourage competition). Tort reform would help lower costs and make health care more affordable. These are good ideas, but they’re not enough. Here are some additional proposals.
In 2010, Dave Petno, an Ohio-based Employee Benefits Consultant and Certified Health Care Reform Professional, convened a group of health insurance professionals called the “Ohio Health Reform Working Group.” The goal was to design a common-sense health reform substitute at the time when it looked like Scott Brown’s election had stopped Obamacare.
Their proposal never caught on with the politicians, but some of the ideas could be rolled into a conservative alternative.
In terms of using the tax code, they suggest “wellness tax credits” of up to $500 for individual for individuals and employers to incentivize staying healthy. Let’s say you want to join a gym — that could be a write-off.) They also endorse the tax-deductibility of all medical expenses (not just premiums.) This would mean people no longer have to set up health savings accounts and jump through the hoops.
One area of ObamaCare, they recommend the elimination of lifetime maximums (some insurance plans cover you only to a certain point. After, say $5 million, you’re on your own.)
Right now, Petno says, you cannot declare bankruptcy to discharge tax or student loan obligations. Why not, he asks, give medical bills the same status? This would be an incentive for people to actually purchase health insurance.
Currently, if your company offers health insurance, and you leave or go out on your own, the only way to keep that same coverage is through COBRA. This means you pay the full premium (which is only fair) — but the catch is that there is a time limit for how long you can stay on COBRA. Why not allow individuals to keep their plans indefinitely? (This sort of portability would be especially helpful for someone with a preexisting condition.)
What about the hard-luck cases? As always, people at the poverty level would get coverage via Medicaid. Vouchers would be available for folks near poverty, and the chronically uninsurable would have access to by coverage in a high risk pool.
But while insurance reform is important, Andrew Langer, president of The Institute for Liberty, believes we should also be discussing how to increase the supply of medical care in America. While conservatives are crafting an alternative, they might consider the law of supply and demand as it pertains to the medical profession.
Langer believes ObamaCare forces a “feedback loop” which”exacerbates all of the factors that are currently decreasing the supply of medical care in America” and driving up cost.
Regarding the so-called “doctor gap,” he asks an obvious question: “Why are doctors getting out of the business?” The answer seems to be a combination of onerous paper work, frivolous lawsuits, and the cost of medical education as topics to address.
Langer also raises concerns about medical licensure, and suggests medical licenses should apply across state lines. For example, if a radiologist could work remotely from another state — without having to jump through a lot of hoops — that would theoretically drive down costs. To be sure, some conservatives might balk at this as an attack on federalism, but Langer thinks our current laws are “arcane” — and that this is a proper role of the federal government under interstate commerce clause.
