Mar 10, 2017
This commentary originally appeared in The National Review on March 10, 2017.
As Washington people go around doing Washington things and talking to other Washington people about Washingtonfocused healthcare reform, we would do well to take a step back to simplify the debate in front of us.
We are the most prosperous country in the history of the world. As such, we have many of the best hospitals, doctors, nurses, and medicines available. We have hundreds of insurers that take risk — for profit — to insure us. We have fairly broad, but expensive and not always effective, social safety nets in which we pool our resources through taxation in an effort to help those who need it.
But the truth is, we have a very badly broken healthcare system. We are losing doctors by the thousands. Healthcare costs have been skyrocketing and insurance premiums are increasingly flatout unaffordable. Insurance companies are no longer serving vast swaths of our country — leaving people with no choices and reduced access to care. Americans, in short, are no longer able to get the health care of their choosing from the doctor of their choosing at an affordable cost.
Very few people dispute these facts or the need to reform health care. So we now confront a choice between two paths – and when we make this choice, it is highly unlikely we will reach a similar fork in the road.
Path One is to do something different – to acknowledge the failures of Obamacare, which are massive, and then do a very unWashington thing and honor commitments made to fully repeal it (which have been numerous), and actually roll back a federal mistake. Then, make a fresh start, with two simple steps. First, freeze Medicaid enrollment immediately and send Medicaid dollars to states with zero strings attached to allow them to innovate and be more effective. Second, increase portability and decrease costs through increased competition, by equalizing the tax treatment between employers and individuals.
If we choose this path, we will, in essence, be saying: Let competitive markets and the states clean up the mess Washington created. Drive down costs through unfettered competition, and increase the number of doctors competing for our business. Cost is the problem. Coverage will naturally increase if costs are lowered and will provide far better healthcare options for far more Americans.
Furthermore, we should give states maximum flexibility to create programs for the poor and those lacking access to care as well as to create innovations such as highrisk pools and targeted healthsavings accounts for those without insurance. The benefit would extend beyond health care, to creating more unity in our country through federalism – allowing us to accommodate our differences.
Path Two would be businessasusual, in which we listen to Washington insiders tell us how they are going to construct a healthcare system for us. That path is – essentially – what we were given this week by the House Republican leadership. That bill, as has been widely observed, is Obamacare 2.0 – in which the subsidies, regulations, and Medicaid expansion of Obamacare have been “replaced” with . . . subsidies, regulations, and Medicaid expansion.
In the words of the great Texan Hank Hill, the bill comes straight from “Rancho Unicorno.” The Republican leadership would like you to believe that they can maintain most of the Obamacare costincreasing mandates, as well as the massive taxpayerfunded subsidy scheme, and that this is not going to increase costs for consumers and taxpayers.
They would further have you believe that a threeyear delay in freezing Medicaid enrollment won’t cause a rush to enroll and drive up costs. That pushing ablebodied people into Medicaid won’t clog up the system and dilute care. That continuing a contraception mandate doesn’t conflict with religiousliberty principles and that continuing a flawed verification system won’t provide coverage for people here illegally. That continuing the same robfromMedicare budget gimmickry is somehow different from the practice they once decried.
These same Washingtonminded folks will come out and tell you, “but we can’t repeal all of Obamacare in the Senate.” This is simply false. The idea is that the unelected parliamentarian of the Senate will rule that repealing Obamacare regulations in Obamacare cannot be done under the “reconciliation” process – i.e., with just 51 votes –because the regulations do not have a budget impact. But 51 senators can say she’s wrong, and they would be correct — because there is no doubt that the fruit of the poisonous tree, the regulations spawned by Obamacare’s passage (through the reconciliation process) do, in fact, have an impact on the budget. In English? The Senate has the power to fully repeal. It just needs to find the will.
The truth is that the Republican leadership simply does not want to repeal it all. They want to maintain the regulations while promising lower costs – which takes us back to the unicorns. And we don’t want unicorns; we want all Americans to get highquality, affordable health care.
As Americans, we can have the country of our choosing. Remember, “governments were instituted among men to secure [our inalienable] rights” of “life, liberty and the pursuit of happiness.” Governments were not instituted among men to tell us what doctor we can have, how we should be insured, what should be covered, and what should not be covered, or to control any other aspect of health care, for that matter. And the Constitution reflects that truth: It leaves all powers not expressly enumerated to Washington in the hands of the people and the states.
Let states and the American people fix the mess Washington created. Let the laboratories of democracy work. Let free markets actually work. The solution to the healthcare problem begins with full, 100 percent repeal of Obamacare and ends with Americans getting affordable health care of their choosing without interference from Washington. Repeal and Respect.