If the Supreme Court chucks ObamaCare entirely, which looks increasingly likely, Republicans will finally have a chance to redefine the debate. But only if they get educated and put together reform ideas now. . .
For too long, Democrats have defined the health care issue, depicting the U.S. system as an unfettered market where costs run wild, insurers rip off consumers and deny coverage to tens of millions, and big-government “reforms” are desperately needed. None of it is true.
Not only is it politically expedient for Republicans to do so, if you believe, as I do, that the Supreme Court is a political animal (unfortunately), then having a viable plan makes it more likely that those justices on the fence between amending Obamacare or destroying it, will choose the latter option, knowing that a Plan B is on the way.
So what should such a plan look like? It should look as much like a free market as possible. For anything else simply transfers costs and is eventually unsustainable. Here I think are some general rules:
1. States should not be allowed to deny out-of-state coverage. Today a Cincinnatian, for example, is not allowed to drive two miles south to Northern Kentucky to buy cheaper coverage there. All fifty states have erected insurance moats around their borders in order to protect the insurers who operate within. Aside from alcohol, the interstate sale of no other product is so highly regulated by the individual states. Thus, the health insurance market is fragmented, inefficient, and expensive. Furthermore, there is absolutely nothing anti-constitutional or anti-conservative about denying this power to the states. In fact, it’s clearly there in the Commerce clause, and is exactly the kind of thing that the Founders specifically wanted to have happen so that the states couldn’t create their own virtual protective tariffs.
2. There should be no minimum coverage requirements other than for uncapped catastrophic care. The various states today demand between 13 and 70 specific coverages be included in each of their state-approved policies. Insurance is for things you can’t afford, you save money for things you can predict. To make an auto insurance analogy: insurance exists to replace the car, not to replace the tires. Some people will want to opt for “cadillac” coverage. Fine. Let them pay for it. But by not requiring that everyone carry the same expensive plan, more people who either don’t want or don’t need the gold-plated coverage will be able to afford basic coverage that protects them against the worst case. But wait: aren’t there some things that insurers should include because they save money in the long run? Like birth control, to pick a recent example? No. If they are in fact cost savers, then smart insurance companies will include them. Good companies don’t need a federal mandate to make good business decisions.
3. The cost of insurance should be borne by the user. Ideally, people should buy their own coverage, making them more alert shoppers. If your employer was buying your groceries for you, you wouldn’t care what else they bought as long as they included the things you want and need. But if you’re buying your own groceries, you’re far more scrutinizing about what goes in your basket. Additionally, paying for your own insurer incentivizes you to make healthier choices. Why quit smoking, for example, if I don’t have to pay more for coverage? Ultimately, the deductability of employer-provided health insurance costs needs to go away.
4. Health insurance should be portable. Dovetailing with the last item, if you yourself provide your own insurance, you’re less tethered to a job. That’s good for the economy too. Now, if we can just figure out how to get people untethered from their houses . . .
5. Allow states to cap the amount of mandatory care that medical professionals are required to provide to the uninsured. This is the most controversial part of my plan, some would say immoral. But when you think about it, this is no different than the “death panels” that were a feature of Obamacare–and those were for people with insurance! If the Supreme Court doesn’t allow the health insurance mandate (and they shouldn’t), then there must be an incentive that pushes the uninsured toward buying insurance, as well as protects insurers and the insured from extreme damages by those who still won’t. Pick a number: a quarter-million a year, a million dollars a lifetime, something, but cap what insurers and taxpayers have to absorb for those who don’t pay into the system. Anything else would be immoral.
So there you have it: five easy things to get health care back on the right track. And it’s less than 2,700 pages, meaning that when it goes up to the Supreme Court for review, reading the legislation doesn’t violate the Eighth Amendment.