With a Wednesday-night Senate vote, the Republican-led 115th Congress has begun to repeal Obamacare. The outgoing president’s signature law is a $2 trillion scrawl of cost overruns, climbing premiums, skyrocketing deductibles, decreased competition, and canceled health plans for at least 4.7 million Americans. It can’t be scrapped soon enough. But GOP House and Senate leaders should replace it in a way that lets Democrats help build a patient-centered system atop the ruins of Obama’s failed adventure in government medicine.
It will take serious, steady work to enact a market-friendly Patient Power–based alternative to this wretched law. Democrats would vote in lock-step against a solitary replacement measure, if Republicans were foolish enough to compile a colossus that drones on for 2,801 pages, as did the laughably titled Affordable Care Act. Thankfully, there is an easier way.
Republicans should remember that 25 Senate Democrats face reelection in 2018, many of whom — including Indiana’s Joe Donnelly, North Dakota’s Heidi Heitkamp, West Virginia’s Joe Manchin, and Montana’s Jon Tester — represent states that both Mitt Romney and Donald J. Trump carried. Republicans should seek the support of these and other shaky Senate and House Democrats, as well as those who appreciate individual liberty more than do such hardcore statists as Senate minority leader Chuck Schumer of New York and House Democratic leader Nancy Pelosi of California.
Republicans should hold separate votes on one specific replacement measure after another. Each should become effective the second that President Trump signs it into law, leaving Obamacare’s victims immediately free to choose patient-centered health coverage that suits their needs and tastes.
First, senators and congressmen should vote to let Americans own individual, portable health plans, just as they own their auto- and life-insurance policies. Some Democrats will support such legislation.
Second, they should vote to let Americans buy health coverage across state lines. Some Democrats will agree.
Third, they should vote to permit every American to own a portable, tax-advantaged Health Savings Account (HSA). Some Democrats will go along.
Fourth, they should free Americans to launch “association health plans.” If the Rotary Club wishes to offer medical insurance to its 330,000 U.S. members, Uncle Sam should cheer, as will some Democrats.
Then, Republicans should invite Democrats to endorse these individual replacement proposals:
• Allow American employees the same tax deductibility for health insurance that employers now enjoy.
• Give Americans affluence-tested tax credits to help purchase health coverage, and make them refundable for the poor. Such credits and subsidies should be transferrable to HSAs.
• Free Americans to deposit Flexible Spending Account monies and Medicare, Medicaid, and Social Security survivor’s benefits directly into their HSAs, as Pacific Research Institute president Sally Pipes advises.
• Let all Americans voluntarily purchase low-cost, catastrophic-coverage health plans, which Obamacare forbids for those older than 29.
• Eliminate all federal support for certificates of need for new or expanded hospitals. Anyone who wants to launch or grow a hospital should be greeted with roses, not red tape.
• Let states use Medicaid block-grant funds to implement medical-malpractice courts and other litigation reforms.
• As Hudson Institute senior fellow Jeff Anderson recommends, terminate federal “community rating,” which forces insurers in a given area to charge a 30-year-old triathlete and a 60-year-old, morbidly obese chain smoker precisely the same premium.
• End federally mandated “essential health benefits.” In the individual and small-group markets, Obamacare — among many other things — forces childless Americans to buy pediatric vision and dental coverage for kids they do not have and never may want. Enough!
• Let doctors and other medical professionals partially or fully deduct from their taxes the dollar value of free care that they offer to the poor and uninsured.
• Free insurers to deduct some or all of their premiums from chronically ill “un-insurables.” This will encourage them to cover those with diabetes, cardiac disease, multiple sclerosis, and other serious ailments.
• Allow states to launch high-risk pools for those with pre-existing, difficult conditions.
• Let Congress open a risk-pool and a malpractice court in Washington, D.C., which it governs.
#related#Rather than tell their constituents why they fought such common-sense reforms, some Democrats will back some of these ideas.
Slowly but surely, as if meticulously constructing the foundation of a sturdy new structure, Republicans will nail one repeal plank beside another, with some Democratic nails also pounded into the boards. This effort will focus and unite Republicans and divide and confuse Democrats.
What America badly needs is a pro-market alternative to Obamacare that replaces the government-patient relationship with the doctor-patient relationship. This new system will be built to last, especially if Republicans install it one piece at a time, and constantly make Democrats offers to cooperate that they can’t refuse.
Editor’s Note: This piece has been amended since its initial publication.