The center-right crowd is sometimes labeled a movement of opposition rather than proposition. While it’s true that Bill Buckley’s aphorism on standing athwart history, “yelling Stop, at a time when no one is inclined to do so,” still rings true for many, commonsense policy reforms have emerged from the right that empower greater freedom for consumers, students and families.
In his new book, Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care, Phil Klein, Commentary Editor for the Washington Examiner gives an accessible survey of the many conservative and libertarian alternatives to the Affordable Care Act (ACA). The sheer breadth of these detailed proposals rebuts the stereotype of Republicans as mere obstructionists, and Klein’s conversational style animates otherwise dry, arcane policy details for non-Beltway readers.
The deeply unpopular law passed by Democrats with no Republican support is even less palatable for Americans today than before its creation. Klein reports that since 2000, Gallup has asked whether it was the federal government’s responsibility to make sure all Americans have health care coverage. Before ObamaCare, some 69% of respondents said yes, but that figure dipped to just 45% afterward (with 52% saying “no”).
“Republicans lost the health care debate when they failed to put in place a comprehensive free market plan when they were in charge. One possible interpretation is that, in theory, Americans supported the idea of expanded coverage as long as it didn’t affect their medical care,” Klein writes, “but that once they were exposed to the fact that, in practice, it meant premium increases, cancelled plans, more taxes and spending, and an erosion of choices of doctors and hospitals, they changed their mind.”
Klein writes that repealing ObamaCare is essentially a litmus test for any federal GOP candidate, “But repeal is not enough … If Republicans achieve repeal but do not agree on a way to reform health care along free market lines, it’s inevitable that Democrats will eventually lead another overhaul of the system that would grant even more power to the federal government than Obamacare does.”
Historically, Klein concedes that healthcare policy has never been an issue that excited the conservative base. He says this traditionally was a motivating issue for conservative activists when it comes to opposing liberal attempts to expand the role of government, as in the case of Hillary Clinton’s scuttled healthcare attempt in the 1990s. And he argues this lackluster interest in expanding healthcare coverage (beyond the Medicare Part D prescription drug rollout under George W. Bush, which The Manhattan Institute think tank and others report is operating below projections because of its market-based structure) ended up coming back to haunt Republicans.
“Republicans didn’t lose on health care when Obama won in 2008, or when he signed his bill into law in 2010, or even when the law survived a Supreme Court challenge and he was reelected in 2012,” Klein writes. “Republicans lost the health care debate when they failed to put in place a comprehensive free market plan when they were in charge.”
He runs through the gamut of center-right proposals: Reform School, Replace School and Restart School, with each camp in that order becoming more progressively free-market and less government-centric. Members of all three schools appear willing to create high-risk pools to subsidize the sickest Americans with pre-existing conditions.
The most conciliatory school, Reform, comprised of activists like Avik Roy, would leave portions of the ACA intact and work within the exchange system by increasing rates charged to older consumers and reducing income levels at which families could receive subsidies. His plan would also repeal the ACA’s Medicaid expansion, nearly all of its tax increases, and most of its insurance regulations. Roy, in tandem, would also reform Medicare by increasing the retirement age and gradually shift seniors onto the reformed exchanges. This would reportedly cover more people than under the ACA at a lower cost.
Replace advocates such as Sens. Tom Coburn, Orrin Hatch and Richard Burr, the 2017 Project and Yuval Levin, would repeal the law but seek universal or near-universal coverage through cutting costs, most commonly through tax subsidies rather than tax deductions. Klein reports subsidy vs deduction is a heated policy dispute among members of the center-right movement since it would amount to government spending vs. foregone revenue. And most would leave Medicare for another battle.
Various Restart proposals, those that would shift the baseline on healthcare spending as if ObamaCare never happened, come from Republican Study Committee, Louisiana Gov. Bobby Jindal and the libertarian Cato Institute, and would save the most taxpayer money. But they would insure the least number of people and are perhaps least politically feasible, at least if Republicans were willing to compromise. Klein argues that Obama was uncompromising and willing to sacrifice Democratic congressional majorities to advance his healthcare agenda, and perhaps this might be a worthwhile tack for conservatives if they believe it would create a lasting solution. Restarters are concerned that the other camps would create “ObamaCare Lite,” by conceding that universal coverage is worthwhile, as ObamaCare seeks.
And indeed, as Klein reports, Obama wanted a complete government takeover of healthcare, a single payer system; he said so on the campaign trail in 2008. “But the problem is we’re not starting from scratch,” Obama said then.
Klein points out that tax credits to companies for providing healthcare coverage limits affordable insurance choices for workers by limiting the number of plans offered by employers.
“Roughly 95 percent of those insured in the U.S. are covered either through the government or their employers, and thus have little control over their health insurance options”
“When you add up Medicare, Medicaid, Obamacare, and employment-based insurance, roughly 95 percent of those insured in the U.S. are covered either through the government or their employers, and thus have little control over their health insurance options,” he says. “Individuals don’t get the same tax benefit as employers buying health insurance, so instead of gross earnings have to pay taxes and buy insurance out of the smaller amount of money left over.”
Reporting on data from the Journal of the American Medical Association, Klein shows that plan choice in the private sector helps reduce costs as companies compete. Whether Republicans can shift the nation’s healthcare system toward one focused on empowering the consumer through choice might mean sacrificing employer-based healthcare plans, which has proven fraught with political difficulty.
A ruling favoring the center-right movement under the pending Supreme Court King v. Burwell could completely unravel much of the ACA, which would create an opportunity for Republicans to offer an alternative that would be difficult for Obama to veto. This obviously would require a complex evaluation of politics and principles.
“Those who aren’t happy about the direction of American health care need to start the process of coalescing around an alternative approach,” Klein concludes. “If they can do that, there’s a chance to overcome Obamacare and move toward a health care system that puts the consumer first.”
Read the original story here on Opportunity Lives…
Carrie Sheffield is the founder of Bold. She is passionate about storytelling to empower and connect others. A founding POLITICO reporter, Carrie contributed on political economy at Forbes and wrote editorials for The Washington Times. After earning a master’s in public policy from Harvard University, she managed credit risk at Goldman Sachs and researched for American Enterprise Institute scholar Edward Conard. She earned a B.A. in communications at Brigham Young University and completed a Fulbright fellowship in Berlin.