by James A. Bacon
Yeah, I’m bummed out by the Supreme Court ruling on Obamacare, although it does contain a silver lining in declaring that there is a limit to Congress’ ability to invoke the Interstate Commerce Clause to regulate anything and everything. That’s no small consolation.
And, yeah, I do feel lied to. The health care mandate is legal because it’s actually a tax? Really? How, then, do we account for President Obama’s response when George Stephanopoulos interviewed him in September 2009?
Stephanopoulos: But you reject that it’s a tax increase?
Obama: I absolutely reject that notion.
Obama seems to embrace the tax descriptor now. So, Obama lied. But what else is new? Americans are so inured to politicians’ lying that the only people who care that Obama lied in 2009 are those who oppose Obamacare anyway.
Here’s what really makes me upset. Congress never would have passed Obamacare if Republicans had articulated a credible alternative to making health care more affordable and accessible. The elephant clan floated some ideas but they never cohered in the public discourse. Obamacare prevailed because there was a vacuum of ideas. Here’s the approach that I advocated in “Boomergeddon”:
- Get employers out of health care, Eliminate the tax preference for health care insurance purchased through employers. When people see their health coverage paid for by a third party, they don’t care what it costs. Health insurers need to design health plans adapted to the needs of the patients, not their employers. (Rep. Paul Ryan, R-WI, proposes to eliminate the health care tax exemption and to reform Medicare but does not go beyond that.)
- Promote the right kind of insurance competition. State and federal mandates of insurance benefits must stop, and people must be allowed to acquire insurance that fits their needs and their budgets. Meanwhile, insurers need to reinvent their relationship with the patient. Instead of acting as HMO-like gatekeepers that say, “No,” they need to empower patients to seek the best value (cost and quality) for treatment of their medical conditions.
- Create market transparency. One of the biggest obstacles to market-driven health care is the fact that, er, there is no market. We must make price and outcomes data more transparent.
- Eliminate barriers to business innovation. The future belongs to multidisciplinary teams that specialize in treating chronic diseases and complex medical conditions with superior efficiency and superior outcomes. But over-regulation of the health care industry impedes the ability of health care providers to reorganize themselves into “focused factories” that excel in treating specific maladies. Those barriers must be pulled down.
In the wake of the Supreme Court ruling, Republicans have renewed their rallying cry to repeal Obamacare. But they can’t replace something, no matter how flawed, with nothing. If Obamacare were repealed, health care would remain unaffordable to tens of millions of Americans. How do Republicans propose to make it more affordable? Sprinkling “free market” fairy dust on the health care system won’t do anything. Free markets will not spontaneously arise from the regulatory wreckage that this nation has created over the past 60 years. Republicans need to put in the hard work of figuring out how to make markets work. If they fail to do so, Democrats win the debate by default.