Conservatives hate Obamacare. Most Americans seem to agree. But as the law gets ready to turn five, where is the plan to do something about it?
Nobody has thought more deeply about that question than the Washington Examiner’s Philip Klein. In his new book “Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care,” he provides some answers.
Klein knows the health care law inside and out, but more importantly he is fluent in the conservative alternatives. He discussed the way out of Obamacare in an interview with The Daily Caller.
Liberals hate it when people call Obamacare a government takeover of health care. Explain why they’re wrong.
Sure, Obamacare didn’t immediately turn the United States into a fully socialized system overnight, but it did put America on the pathway to such a system, which is also described in health policy circles as “single payer.”
Obamacare adds millions of people to the rolls of government-run Medicaid and then distributes government subsidies to individuals so they can buy government-designed insurance on government-run exchanges. And you don’t have to take it from me. Even liberal economist Paul Krugman wrote in The New York Times that Obamacare was a “Rube Goldberg device” that “relies on a combination of regulations and subsidies to rope, coddle, and nudge us into a rough approximation of a single-payer system.”
A standard Democratic talking point is that there have been 40-odd Republican votes for Obamacare repeal, the GOP hasn’t filled in the details on replace. How fair is that criticism?
The fairest way of putting it is the way Sally Pipes of the Pacific Research Institute put it to me in my book — the problem isn’t that Republicans haven’t had any plans to replace Obamacare, the problem is that they’ve had too many.
That is, individual members of Congress and outside policy experts have presented a number of ideas for overhauling the health care system, but due to differences (some technical, others more deeply philosophical) Republicans haven’t been able to rally around a single one. So, it’s been easier to just focus on their united opposition to Obamacare.
The main reason I wrote “Overcoming Obamacare” is that I don’t think that’s a sustainable position. I want to jump start the process of getting to an alternative, so I decided to take the often opaque jargon-filled health care debate that occurs within the confines of the Washington policy community and translate for a broader audience.
Introduce us to the major conservative schools of thought on what to do about Obamacare.
Having surveyed the landscape, spoken to dozens of influential policy experts as well as lawmakers such as Paul Ryan, Bobby Jindal, and Tom Price, I identified three different approaches.
The first approach, which I call the Reform School, comes from those who believe that full repeal of Obamacare is unlikely now that the law can claim millions of beneficiaries, but that Obamacare can still be reformed in a way that tilts the nation’s current trajectory toward a more market-oriented direction.
The second approach, the Replace School, comprises those who argue that Obamacare needs to be fully repealed, but that this can only be achieved if Republicans offer an alternative that helps make insurance broadly affordable and has an answer to Obamacare’s current beneficiaries.
Those who adopt the third approach, which I call the Restart School, believe that Obamacare needs to be completely scrapped (along with all of its taxes and spending) and that instead of engaging on the Left’s playing field by trying to compete with Democrats on coverage numbers, Republicans should work from a clean slate to bring down costs by fostering a free market.
How much is Republican disinterest in health care policy to blame for Obamacare in the first place?
A lot. After Hillarycare went down in flames in 1994, Republicans largely retreated on the health care issue. They never used their time in power to truly advance free market reforms, and to the extent they did anything on the issue, it was to expand government — as President Bush did with the Medicare prescription drug plan and Mitt Romney did as governor of Massachusetts.
While Republicans were ignoring the issue, Democrats were taking the time to retrench, learn from their mistakes, and set the stage for their next health care push whenever they retook power.
Speaking of Republicans responsible for Obamacare, how do you feel Mitt Romney (the subject of your last book) potentially running for president again will affect the GOP’s anti-Obamacare campaign?
It depends on how he does. In the primaries, savvy opponents could point to Romneycare as an example of precisely the wrong approach for Republicans to take on health care. In the general election, however — if Republicans were to make the mistake of re-nominating Romney – his candidacy would be a disaster for supporters of market-based health care solutions.
As we saw in 2012, because he is responsible for creating the plan that served as the model for Obamacare, he has no credibility in arguing against the mandate-and-subsidize approach. He failed utterly in 2012 – releasing some vague health reform ideas that he never talked about during the campaign. Another Romney nomination would cement Obamacare in place.
Do you see single payer in our future, or does the failure to implement a Canadian-style system in Vermont show us it just can’t work here?
I don’t think that the Vermont experience tells us much about what could happen in the future. Remember, Democrats failed miserably trying to get a national health care plan passed in 1994, only to succeed 16 years later. As it is, a combination of Obamacare, Medicare and Medicaid merely growing on auto-pilot puts us on a course toward single payer. And if Republicans don’t advance an alternative when they have an opening, Democrats will wait for the right chance to build on Obamacare.
What lessons can Republicans take from the Democrats’ efforts to pass Obamacare?
Democrats could have given up on something as ambitious as Obamacare when the polling turned bad relatively early in the legislative process. But they persevered, despite the political risks. Yet they didn’t act in a total vacuum. From the perspective of liberals, the final bill represented a compromise from something closer to single-payer – but the liberals supported it anyway.
I think (and I’m arguing from the perspective of somebody wanting to advance conservatism) what Republicans can learn from this is that sometimes it’s worthwhile to risk political defeat to advance an agenda. But also, sometimes the base of your party has to be willing to settle for a field goal.
Wouldn’t real free-market reforms also fail the “If you like your doctor/health plan, you can keep your doctor/health plan” test?
Yes. Any major change to the health care system — whether it’s moving to Obamacare, or to a more market-based system from Obamacare – is going to cause some disruption. The plans I look at in my book try, in different ways, to limit that disruption – or at least make it more gradual. But it’s important to draw a distinction between a market-based reform that causes short-term disruption in the name of giving individuals more choices and control over their health care dollars and an Obamacare-style overhaul which dislocates people in the name of forcing them to purchase policies designed by the federal government.
What are the odds we will see an end to Obamacare?
The more people that buy “Overcoming Obamacare,” the better the odds it will be vanquished.
W. James Antle III is managing editor of The Daily Caller and author of the book Devouring Freedom: Can Big Government Ever Be Stopped? Follow him on Twitter.