December 31, 2008 | Commentary on Health Care
A camel, they say, is a horse designed by committee. To take the expression further, let's call it a committee of experts. After all, only "experts" could take something as graceful as a horse and replace it with something as difficult as a camel.
And that brings us to health care.
During his presidential campaign, President-elect Barack Obama promised to help uninsured Americans obtain coverage. But, "If you already have health insurance, the only thing that will change under my plan is that we will lower your premiums," he told an audience in Canton, Ohio, in October. "If you don't have health insurance, you'll be able to get the same kind of health insurance that members of Congress give themselves."
Unfortunately, that promise could be undermined by Obama's nominee to be secretary of Health and Human Services. Former Sen. Tom Daschle advocates creating a "Federal Health Board" to oversee the one sixth of the American economy that's spent on health care.
That's a bad idea. Moreover, it directly violates Obama's pledge that Americans will be able to retain the same kind of coverage--and coverage choices--they have now.
In his recent book "Critical: What We Can Do About the Health-Care Crisis," Daschle proposes a Federal Health Board that would "help define evidence-based benefits and lower overall spending by determining which medicines, treatments, and procedures are most effective and identifying those that do not justify their high price tags." In other words, an omnipotent board of experts would determine which drugs, tests and medical treatments will--or will not--be approved for coverage. Patients and their doctors wouldn't have any say in the matter.
Daschle certainly sounds a different note from his future boss. While Obama insisted patients would remain in control of decisions regarding their health, the potential HHS secretary admits, "Doctors and patients might resent any encroachment on their ability to choose certain treatments." As well they should, since each patient deserves to be treated as an individual, not as a medical condition.
The former senator writes that even he has some worries. The power of the board he advocates "is not small, and delegation over health policy decisions rightly raises concerns," he writes. Still, Daschle supports massive interference in the health care market, interference that could eventually affect virtually everyone.
There's a better way to cover more Americans.
First, the incoming Obama administration should ask Congress to change the way the tax code treats health insurance. Today, employees get unlimited tax relief for employer-provided coverage, but families without coverage through work don't enjoy similar benefits.
Experts on the left and the right agree this should be changed, by capping the benefit an employee may deduct and by providing direct assistance, either in the form of a voucher or a refundable tax credit, to help lower-income workers buy private coverage.
Lawmakers could also expand coverage by exploring something called "auto-enrollment." There are certainly working Americans who cannot afford to buy health insurance. But for some, the reason they aren't in a plan is because they never get around to signing up. Even worse, there are some who figure they can always get care at an Emergency Room, so having insurance isn't a real concern for them.
If workers were automatically enrolled in their company's health care coverage, and were required to actively decline coverage if they didn't want it, many more Americans would have private coverage.
Finally, the federal government should encourage states to experiment with new ways to cover their citizens. If Washington made it possible, states could restructure programs and find creative ways to expand insurance. Federalism works, and often generates innovative ideas that can be applied nationwide.
This New Year begins with "hope" for "change" in Washington and across the country. The president-elect can and certainly should keep his campaign promise to expand health insurance coverage -- only by expanding the private insurance market, not by replacing it with a system designed by politically appointed so-called "experts."
Ed Feulner is president of The Heritage Foundation.