Critical Condition

NRO’s health-care blog.

Massachusetts Presses Reset Button on Health Reform


On Tuesday, Massachusetts voters elected Republican Scott Brown to the Senate, thereby shifting the initiative on health care to the GOP, which now has the votes needed to filibuster any legislation. Will the Republicans use this opportunity wisely?

Maybe not. These are partisan times. Some will be tempted to obstruct the president’s agenda as before, delaying even the simplest health reforms for yet another year. This would be a mistake, since American health care — with its ever-rising costs and uneven quality — is in need of a fix. Yes, Democrats were wrong to try to bog down Congress with a giant, complex, and costly reform bill. But Brown’s victory is an opportunity for Republicans to correct that mistake, not to compound it.

And quite a correction is needed: 2009 was an exercise in how not to reform American health care. The White House’s determination to pass health reform, and to pass it along partisan lines, meant that policies were lost in the process. Health reform was supposed to reduce premiums for working Americans; but CBO estimates suggest that Obamacare would increase premiums. The White House sought to “bend the curve” of rising health costs — then promptly negotiated away the needed provisions, leaving draft legislation that would increase overall health spending. More competition through a national health exchange? In a compromise with the Senate, that was watered down to 50 unworkable state exchanges.

In short, the president’s health-reform legislation is an awful lot of legislation, and not a lot of reform.

In contrast, Senator-elect Brown won a mandate for a different kind of change. He defended “the existing private market system,” but he also called for changes to “drive down costs and make it easier for people to purchase affordable insurance.”

Senator-elect Brown’s victory isn’t an opportunity to stick it to the president; it’s an opportunity to mend fences — and mend bad legislation. It’s a chance to reconsider market-friendly health-insurance reforms in a smaller bill, one that both parties could support. Buried deep in Obamacare’s thousands of pages, the core of a bipartisan bill exists.

A modest alternative would: (1) create a national market for health insurance, modeled on the benefits enjoyed by members of Congress — rich in options for families but without burdensome regulations that increase premiums; (2) protect consumers with simple rules to prevent unfair insurance cancellations and improve portability; (3) help those who need help, like the millions of Americans with pre-existing conditions; and (4) create and protect market incentives for wellness.

That last provision, which is so often mentioned in speeches by members of both parties, is lacking in both the House and Senate bills. But a broader strategy on wellness is critical. After all, the president’s mantra in 2009 was that “health reform is deficit reduction.” That’s not simply true for a more efficient system; it’s true for a healthier and more productive nation.

Meaningful health reform, then, would also focus on attacking America’s unhealthy habits — for instance, by giving insurers more legal room to reward healthy behavior, as Safeway does through its own self-insurance plan (for the record, Safeway has seen zero percent health inflation for the past four years). To control rising Medicare and Medicaid costs, a bipartisan approach could replace Obamacare’s wellness grants to community groups with incentives for Medicare and Medicaid patients to improve their diet, stop smoking, and get fit, thereby generating long-term savings (and better health) faster than plans to ration Medicare ever would.

Massachusetts voters have pushed the reset button. So, reset — don’t retrench. If Republicans could introduce a modest, attainable health-reform bill that both parties can support, the White House could save face and take credit for starting the debate in the first place. And would that be so bad? After all, Republicans could also take credit for giving Americans what they actually want: increased insurance competition, fairer consumer protection, more compassion for those in need, and maybe even better health.

Massachusetts has sent a message: This is a moment for better policy, not partisan politics. Let’s hope Congress hears the message clearly.

– David Gratzer, a physician, is a senior fellow at the Manhattan Institute. He is the author of Why Obama’s Government Takeover of Health Care Will Be a Disaster.


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