Posted on 08/06/2013 1:22:46 PM PDT by SeekAndFind
Conservatives and libertarians have criticized the IPAB “death panel” that Obamacare endows with the authority to make top-down decisions about Americans’ health care. They’ve discussed how mandates for religious employers, businesses, and individuals run counter to the Constitution and the principle of personal choice. They’ve issued calls for Republican governors to resist Medicaid expansion in their respective states in order to impede the law’s implementation.
But now a number of conservative groups have issued a blanket Obamacare ultimatum: “If you fund it, you’re for it.”
Conservatives of all stripes are united in their opposition to Obamacare. But we are not united in what we might want in its place. If not Obamacare, what kind of health reform do we want? How should our values be reflected in policy, and why?
We have failed to engage those questions at a deep level, and we have struggled to articulate and defend our answers in a way that resonates with most Americans. Obamacare is now law, and our agenda for health reform is rooted in opposition — not in making the case for how conservative principles can serve as the foundation for something better. Today AEI is launching a big-think proposal for comprehensive health reform that aims to fill that gap and spark substantive discussion. Titled “Best of Both Worlds” and authored by eight renowned economists from Harvard, Stanford, the University of Chicago, and the University of Southern California, the plan puts forward a market-based post-Obamacare replacement that guarantees both universal coverage and individual choice. It was formulated to answer a basic question: “If we could design the health-care-financing system from scratch, what would we build, and why?”
The plan itself begins with staples of center-right replacement thinking, such as eliminating the income-tax exemption for employer-based health insurance and providing all Americans with a sliding-scale subsidy to purchase private insurance on their own. It then joins these proposals to a new concept only implied in current center-right thinking: full, individualized, market-based pricing.
Every American would be given enough support to purchase a privately sold and administered catastrophic health-care plan, while private insurers would be freed to (a) use an individual’s health information to price the policy and (b) design whatever other policies it believes consumers would want and pay for. That puts the poor and the rich on more equal footing by replacing Medicaid (widely recognized as a second-tier system) with private coverage. It guarantees universal coverage without mandates by providing a basic plan at no cost to all Americans, with more generous coverage for the poorest and sickest. It introduces greater competition among insurers by fostering competition across state lines. And its substitution for Obamacare saves more than $60 billion over ten years.
By offering a proposal that marries a progressive emphasis on equity and protection with a conservative vision of market competition and choice, “Best of Both Worlds” neatly forces everyone debating Obamacare and health-care policy to confront the basic values at play and therefore to think through their policy implications.
The plan raises tough questions for conservatives and libertarians. Do we find distasteful any flavor of federal financing used to help low- and working-class-income Americans purchase health care? If so, or if not, why?
More broadly, is health insurance simply another commodity that some individuals are able to purchase and others are not? How does that interact with the uniquely conservative emphasis on the dignity of the individual? This plan suggests that health care is not just a service and that Americans’ altruistic impulse favors devoting some funding to a well-designed program that ensures care for society’s most vulnerable.
It confronts progressives with serious questions, too. Though Obamacare will greatly reduce the number of uninsured Americans, it will still leave 20 million uncovered a decade from now. And it is likely to make insurance less affordable for many who are already covered. Are progressives willing to consider an alternative policy that better realizes their overarching goals? Or are they politically yoked to a plan many privately agree is poorly designed and needs substantive overhaul? Are they willing to free up private insurers if it improves coverage and affordability for the poor and the sick? If so, by how much? And if not, why?
Progressives, conservatives, and libertarians all have a duty to articulate and defend the values they want to see reflected in health reform. Progressives must confront the dissonance between the policy objectives they sought in Obamacare and the reality of what the law will likely provide. Conservatives must offer a forward-looking policy agenda that proposes substantive solutions along with their criticism of the current agenda. And they must recognize that any politically successful repeal program must include a replacement component that resonates with Americans’ broader beliefs and personal experiences
Ultimately, this plan is just one option out of many. But it seeks to foster a discussion that is long overdue.
— Henry Olsen is a vice president and Brad Wassink is a domestic-policy researcher at the American Enterprise Institute.
How ‘bout GET THE EFFIN’ FEDERAL GOVERNMENT ENTIRELY OUT OF HEALTHCARE!
The current Healthcare “Reform” is simply an attempt to fix the perverse incentives created by PREVIOUS “reforms.”
Except, of course, where it is simply a power grab.
I walk in, I am diagnosed, I negotiate the doctor's fee, he treats me, I pay.
EXECUTIVE SUMMARY:
The US health care system suffers from three
structural flaws. First,it artificially inflates health
insurance premiums for the healthy in an attempt to
lower premiums for the sick.This encourages healthy
individuals to reduce their insurance coverage or
even exit the market entirely, driving up costs for
everyone.
Mandates to purchase insurance and penalties for lack of insurance can serve as cosmetic solutions, but they cannot erase this fundamental problem.
Second, by relying heavily on open-ended fee-for-service public insurance, the present system
rewards costlier high-volume care rather than higher quality care. Perhaps as a result of these incentives to
do more, per capita health care spending in the
United States is the highest in the world,while patient
health outcomes rank much lower.
Third, the poor are funneled into a Medicaid system with reimbursement levels well below those of private payers.
This relegates the most vulnerable groups in America to a
separate and unequal health care system with more
limited access and worse outcomes. The current
system professes to sacrifice some efficiency to protect the sick and the poor, but ultimately it fails to
achieve either efficiency or equity.
We propose an approach to health insurance
reform that promotes high-quality,fiscally sustainable
health care for all. Our solution is a departure from
both the current system and the Affordable Care Act
reforms that begin in 2014.Our approach reorganizes
US health insurance around four principles:
* First, we allow and encourage insurance
companies to charge individualized premiumsto consumers that reflect their true health care costs. This moves away from
the current approach of offering coarse and relatively uniform premiums to the wide range of individuals seeking insurance (through the use of group insurance
or state-level community-rating mandates). This reform provides a firm foundation for a health insurance market that no longer motivates healthy individuals to opt out.
Insurance offerings would be made available in an open market—for example, through insurance exchanges—
with premium transparency.
* Second, to ensure that offers of insurance
are affordable, we propose government financed premium supports. The poor, especially the sick poor, gain access to a basic insurance plan at no cost and to more generous plans at significantly reduced costs.
* Third,we propose eliminating the practical
and legal barriers to multiyear(long-term)
health insurance contracts. Such contracts
protect all Americans from increases in
insurance rates that could accompany
major illness.
* Fourth, we propose to abolish the tax
preference for employer-sponsored health
insurance plans. This subsidy encourages
excess utilization of both insurance and
low-value health care services.It also costs
the federal government nearly $300 billion
in lost revenue—revenue that could be
used to fund insurance forthe sick and the
poor.
Finally, it forces an awkward
bundling of health care and employment
withadverse consequencesforworkers and
firms alike.
Our plan achieves universal coverage by ensuring
that all individuals have access to a no-cost “basic
plan.” It protects the poor and sick by targeting government funds toward subsidies for these groups.
Federal and state governments will be able to specify
in a transparent fashion the level of spending they
wish to incur now and in the future, ensuring fiscal
viability. The use of private health insurers allows
choice for consumers and exploits the incentives of
private firms to encourage the efficient use and pricing of health care services.
In sum, our plan will allow the United States to
eliminate the separate and unequal nature of the
present health care system that limits the health care access of poor Medicaid beneficiaries because of low
reimbursements.All of this is accomplished within a
framework that allows the market to do what it does
best—pricing risk and controlling cost growth—and
the government to do what it does best—ensuring a
distribution of health care resources that is just and
fair. In addition, the federal and state governments
are provided with more flexibility to specify the current and future levels of spending they wish to allocate to the provision of health care.
We believe this plan can unite the country—
young and old, sick and healthy, Democrat and
Republican—in support of a simplified health care
system that improves the nation’s well-being.
A “conservative” system would not involve subsidies of any sort.
RE: I walk in, I am diagnosed, I negotiate the doctor’s fee, he treats me, I pay.
1) What if you were laid off and out of a job?
2) What if the disease is life threatening and you cannot afford the treatment without selling your house?
It's the cost of that care and how to pay for it that everyone is being intentionally confused.
It's really simple (in a complicated ... no .. make that .. extensive way .. )
How much is a band aid.
What is a fair insurance premium to cover the cost of that band aid and fund thew operation of the insure.
That's really it, and anyone that comes in here and tries to confuse that basic concept is a provocateur.
What is a fair insurance premium to cover the cost of that band aid and fund the operation of the insurer ?
Unite the country against it perhaps. You guarantee higher taxes or higher premiums for most working Americans, while having them subsidize those who aren't working
REPEALED!
Yes we find that distastful, because there is no enumerated power of the federal government that gives them the authority to do it. Not sure why that has to be a "tough question". It's not exactly rocket surgery.
Their goal is not affordable insurance and coverage for all, but control over the American public and more importantly, 1/6 of the economy. It is about control and power, not health care ... which is why the progressives think it's just fine and continue to fight for its implementation. We are in the metastasis stage ... once Obamacare spreads via enrollment, it's going to be 'terminal' to freedom and liberty, economic and otherwise.
RE: Yes we find that distastful, because there is no enumerated power of the federal government that gives them the authority to do it.
What about STATE financing?
Well the first thing to do is get “band aids” out of the equation. One of our big problems is the confusion between health “insurance” and health “coverage”.
What did people do before Medicare/Medicaid?
Conservatives of all stripes are united in their opposition to Obamacare. But we are not united in what we might want in its place. …Great; a nice liberal language trick that implies that Obamacare is replacing “nothing” and the alternative to Obamacare proposed by “far-righters” is also “nothing” and can only be replaced by some sort of Obamacare-Lite.
OK, what is the conservative proposal to replace Obamacare?
I don’t see any mention of waste in terms of materials and labor in a general sense and also taking into account uninsured, specifically illegal immigrants and their ilk.
So Obamacare is replacing a dearth of healthcare? I think not.
Coverage is what insurance pays for.
For a dollar 3.98 I get the band aid ... for 2.95 sixty I get the broken leg set.
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