January 30, 2018 by Anders Ingemarson
With tax reform in the books, signs are that Republicans may take another shot at reforming government health insurance and health care in 2018. In a Dec 1 interview with Ross Kaminsky, House speaker Paul Ryan said “We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit. […] Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more of our time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.”
Debt and deficit concerns are valid, but they won’t win the battle for the heart and soul of the American people. As with past attempts, fiscal-only arguments will put Republicans on the defense, with all but a few running for cover every time the opposition accuses them of being cruel and unfeeling bean-counters that disregard the plight of the poor, of those with preexisting conditions, and of Medicare recipients.
If threats of national bankruptcy won’t do it, how do you capture the hearts and minds of Americans? By claiming the moral high ground. No, not the current dominant altruist moral high ground which considers it a duty to support those in need through government taxation, redistribution and regulation. Republicans have tried watered-down versions of altruism before with dismal results: remember “compassionate conservatism”? (nothing wrong with being compassionate, but leave the government out)
To achieve success, conservatives need to claim a moral high ground based on our rights to life, liberty and the pursuit of happiness; the individual rights immortalized in the Declaration of Independence that the founders considered unalienable but that have been routinely alienated since the day they were put on paper. You may say this is so 18th century, but being unalienable means being timeless. It’s time to rediscover them, to make them relevant again; if Hamilton and federalism have 21st century star power, then why not Jefferson and individual rights?
Take Medicare as an example. Instead of defensively arguing for preserving Medicare by making it fiscally sound (that is, longer waiting lines and fewer options—not good selling points), Republicans should go on the offensive arguing that violating the individual rights of American seniors by shackling them to a one-size-fits-all system of healthcare is a moral abomination. We don’t violate the individual rights of seniors by forcing them to use a specific brand of cellphone or car model once they turn 65; why should we violate their rights by forcing a prescribed health insurance and health care scheme down their throats?
Our vision, Republicans should proclaim, is a moral society that respects the rights of individuals to choose health insurance and health care providers, and that respects the rights of health insurers and health care providers to offer any product and service they can find a market for, without the involvement of government force. A vision of a society where health insurance and health care options in old age are as abundant and affordable as cellphones and cars.
Conservatives should turn the tables both on the altruists on the left and within their own ranks and put a face on the immoral individual rights violations in today’s system. Bring up the countless examples of individuals who are suffering because of lack of service or having to wait for treatment, who are lost in the maze of health insurance regulation (the fault of regulation, not insurance companies), and who don’t have insurance because they were laid off and can’t find or afford choices outside employer sponsored health insurance, ACA included.
As for implementation, any health reform initiative, Medicare or otherwise, should start with massive health insurance deregulation. This will create the thriving market place that will give Americans the practical examples of what is possible when individual rights are consistently respected, paving the way for broader acceptance of health insurance and health care free of government involvement. Health insurance deregulation would include but not be limited to the following:
- Allow health insurers to sell any plan they find a market for: catastrophic insurance in different configurations, cafeteria plans offering individuals to pick and choose their coverage, specialized solutions such as pregnancy insurance covering rare birth defects providing impacted families with care and financial assistance, and so on.
- Remove regulations requiring coverage for preexisting conditions (possibly grandfathering in those with current preexisting conditions during a transition period).
- Remove all limitations on offering health insurance across state lines.
- Remove preferential treatment of employer provided health insurance using a combination of incentives: individual tax deductions for health insurance and health care costs, and increased contribution limits to health savings accounts (HSAs), etc.
- Put pressure on states to deregulate their local health insurance markets. This is a thorny issue, but Republicans control enough state legislatures and governorships to do some trailblazing, setting examples in some states creating competitive pressure on others.
It is not unthinkable that restoring individual rights for health insurers to compete without regulatory chains will result in private health insurance out-competing Medicare on both price and performance within a few years for a large majority of reasonably healthy seniors.
This will prime Americans for the final push to fully restore individual rights in health care—repeal ACA and Medicare, rollback Medicaid, completely get the states out of health insurance and health care regulation, and eventually abolish Medicare taxes. Of course, transitional measures will be needed; it has taken 50+ years to get to the current level of individual rights violations and institutionalized dependency on government health care. It will by necessity take time to restore individual rights without unduly hurting those who are shackled to today’s system.
A tall order? For sure, but isn’t this one shining city on a hill Republicans should have the courage to fight for?