September 10, 2009

September 10, 2009 | Commentary on Health Care

At the Danger Point in the Obamacare Debate

Now that many Americans realize the Obamacare bills in Congress herald a government takeover of U.S. health care, they can't afford to relax.

Yes, their voices -- raised in town halls and other forums -- sent surprised liberals and "progressives" scurrying to regroup. A few even repudiated the idea that a "public option" (that is, a government health plan) is necessary to fix the system.

But now is the most dangerous phase, not the time to celebrate, for those of us who believe real reform doesn't involve more government control.

Watch out. President Obama and the liberals on Capitol Hill will come back, one way or another, with alternative paths toward their ultimate goals.

Look for those routes to include:

  • Legislation to enroll millions more children and adults from middle- and upper-middle-class families in the government's ever-expanding children's health program (known as SCHIP).
  • "Rights" bills to make "affordable" health care and drugs the law of the land, which would mean sweeping price controls.

Regrettably, history shows many Republican lawmakers -- conservatives included -- will fall for such ruses so they can vote "for" something.

Of course, conservatives aren't against health care reform, no matter how many times President Obama, the majority leadership in Congress and big media say so. We're simply against their idea of reform.

We are for a conservative vision of health care reform, one based on principles emphasized for years by The Heritage Foundation and others. It's a vision that springs from the traditional American approach of gradualism and experimentation, rather than the European approach of micromanagement and central planning.

Most Americans will share a vision, assuming they hear it communicated, that includes these elements:

  • Proceeding stage by stage, rather than rushing to make major changes in a health care system so big it's equivalent to the world's sixth-largest economy (bigger than Britain). Let's test each stage to be sure it works before building the next.
  • Working agreements between the private sector and state and local governments. They would design simpler but more sensible insurance rules, reinsurance systems and other changes to see that sicker Americans can get coverage.
  • Allowing families to buy and keep the health insurance that suits their needs, regardless of employer or state borders.
  • Making the tax code neutral on insurance choices, rather than biased toward employer-sponsored coverage.

It's time, as President Obama makes his big push this week in a speech to Congress, for more conservatives to talk boldly and plainly about we're for -- expanding meaningful consumer choices and control in personal health decisions. Conservatives can't continue to allow liberals in government and the media to go on parroting the absurd lie that we're "against" health care reform.

What we're dead-set against, like so many Americans who spoke up this summer, is the government-run plan demanded by liberals. That phony "public option" would be used to undermine the private coverage of millions. It has to go.

So does the "fall-back" gimmick floated in recent days by President Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid: an arbitrary "trigger" that forces the public option on the states if a certain target isn't met by a certain date.

Right away, we can do some simple things to expand coverage. For example, millions of uninsured Americans are eligible for private insurance or programs such as Medicaid, yet don't sign up. Let's provide tax credits or other subsidies. Let's make enrollment easier.

Yes, conservatives must do more to address affordability. We can take steps to encourage innovation, creativity and competition -- among the states as well as insurers and care providers.

Folks of good will in both parties already agree one early stage should be creating "shopping malls" for affordable coverage in each state. Consumers would get the information they need to "comparison shop" among plans.

And today, with tax-subsidized, third-party insurance, everyone has the incentive to spend more of someone else's money. No wonder costs are exploding. So let's provide appropriate incentives.

For instance, we ought to convince employers to show employees how much of their compensation comes as health insurance. We ought to limit the tax "exclusion" for health plans, just as we limit tax breaks for 401(k) plans or IRAs. The revenue would provide tax breaks to taxpayers who need help to buy coverage.

Such reforms would encourage all of us to look into whether employer-sponsored insurance is a good value -- or if fatter paychecks and less costly fringe benefits are the better option.

We're more likely to get this right if the federal government simply sets broad goals for coverage and removes obstacles preventing states from trying different approaches. Allow experimentation, then compare results.

That's American federalism. We unleashed it to achieve welfare reform. And it's exactly the opposite of Washington lawmakers' obsession with dreaming up delivery system "game changers" they can impose from coast to coast, European style.

Yes, conservatives must address Americans' fear of losing their insurance or of being trapped in their current coverage. And yes, conservatives must address Americans' desire for transparency in pricing, but without the government butting in and fixing prices -- which would wreck insurance markets.

Insurers will cough up more choices and more information when pressed by competition and innovation.

Americans today consult Travelocity or Priceline in making travel choices. What an American solution if we are able, before long, to log in to a similar resource while making decisions about our health and that of our children. William Shatner, call your agent.

Stuart M. Butler, Ph.D., is Vice President for Domestic and Economic Policy Studies at The Heritage Foundation.

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First Appeared in Townhall