Americans rank health care as one of their top domestic concerns; Democrats are heavily favored on the issue; and Barack Obama campaigns on his health-care plan. What’s a Republican to do?
The GOP can start by attacking Democratic overreach. Americans dislike big-government programs. They dislike wage and price controls. They hate being told what to do. Yet, in many ways, those are the core principles of practically every major Democratic health-care proposal today. Republicans should remind voters of the heavy-handed features of Democratic plans — the very features they rebelled against in 1994.
The temptation is to stop there, and content themselves with derailing wrongheaded policies. But this time, the GOP can’t stop there — it’s not 1994 anymore. Republicans need to understand that it’s simply not enough to oppose the changes Sen. Obama and others are supporting. Americans need a solution this time, not just a counter-argument.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ADVERTISEMENT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Fortunately, Sen. John McCain has bold ideas to remake American health care. The presumptive GOP nominee promises to focus on cost, not coverage. And he starts with a recognition of reality: our present system, rising out of World War II-era wage and price controls, allows employers, but not families, to pay health-care premiums in pre-tax dollars. This costs the treasury more than $200 billion a year, vastly more than, say, agricultural subsidies. In this employer-centered system, individuals pay directly just 13 cents of every health dollar. This payment structure contributes to rising health costs, sapping American economic competitiveness and endangering middle-class prosperity.
McCain proposes scrapping 60 years of bad tax policy and getting employers out of the health-insurance game. Instead, every family would receive a tax credit to purchase their own insurance, either directly, or through their union, trade association, or church. This would not only make health insurance portable, but would also encourage people to pick more basic coverage and to shop around for routine care.
Under McCain’s plan, Americans will have the opportunity to get health insurance that follows them from job to job, an idea particularly attractive to what Ross Douthat and Reihan Salam call Sam’s Club Republicans — conservative-leaning Americans of modest means. McCain’s plan would be even stronger if he addressed four additional proposals:
Foster competition
American health care is the most regulated sector in the economy. The result? A health-insurance policy for a 30-year-old man costs four times more in New York than in neighboring Connecticut because of the multitude of regulations in the Empire State. Americans can shop out-of-state for a mortgage; they should be able to do so for health insurance.
The regulatory insanity affects all aspects of health care. Consider: Americans have a choice of reflexologists who will stick a candle in their ear to cure their heart disease, but state and federal governments restrict the choice of hospitals if Americans want to get surgery by a board-certified heart surgeon. A McCain administration would commit itself to foster competition at every level.
Increase transparency
Competition is of limited use if people have no access to data on pricing or quality. It’s great to have a choice of hospitals, but how to tell which excel and which don’t? American health care today is a “black box” — a closed system where little information flows out. McCain would not only release all federal government data, but also compel anyone receiving federal grants or compensation to do the same — which basically means everyone.
Reform Medicaid as they did welfare
Like Aid to Families with Dependent Children, the federal government’s old welfare program, Medicaid is expensive and deeply flawed. One of the fastest-growing government programs, Medicaid leaves inner-city children with coverage on paper but unable to access specialists, while wealthy seniors use the program to subsidize their long-term care. Between 1980 and 1995, the program’s costs quintupled, yet health outcomes remain far worse than in private plans. Even the New York Times declares the program rife with “waste, fraud, and abuse.” Part of the problem stems from the fact that the program is shared between the federal and state governments — and is thus owned by neither. A McCain administration will seek to fund Medicaid with block grants to the states, and then let them innovate.
