Divided Republican senators are scrambling this week to repeal and replace the wizened monster called Obamacare. Most conservatives want more consumer choice. Some moderates want more money for Medicaid expansion and opioid-addiction treatment.
To bridge this gap, McConnellCare should offer more voluntary features and expand medical freedom: Give doctors and patients more options. For conservatives, these can be the spoonfuls of sugar that make the Medicaid go down. For moderates, giving patients numerous paths to health takes nothing from anyone.
These ideas would help:
• All Americans should be free to own voluntary health savings accounts (HSAs) that they would control and transport among jobs, schools, and new homes in other states. Funds could be spent on insurance premiums, drugs, or medical devices, or be saved for future health needs.
• All Americans should be free to buy insurance across state lines. Indeed, insurers should be allowed to offer coverage from California to Maine in a single, national free market. Visualize GEICOCare. This deprives no one of anything.
• All Americans should be free to purchase simple, low-cost, catastrophic coverage devoid of bells and whistles.
• All Americans should be free to launch and join association health plans (e.g., Junior LeagueCare or UCLA AlumniCare).
• Senator Ted Cruz (R., Texas) wisely proposes that any insurer that offers an Obamacare-compliant plan also may sell whatever other policies it wishes. This could include stripped-down, inexpensive coverage with few if any of Obama’s paternalistic mandates, especially community rating (by far, Obamacare’s most explosive cost accelerant) and “essential health benefits.” It is grotesque for Washington to force gay couples to purchase mandatory “free” birth control and compel childless Americans to buy pediatric dental benefits for offspring they never offsprung.
• End community rating. The idea that everyone in a community should pay the same for health insurance — whether they are skinny, vegan yogis or bulbous, chain-smoking couch potatoes — is as absurd as charging 16-year-old boys and 56-year-old grandmothers the same price for auto insurance. Insurers should be free to adjust prices to reflect risks.
If sedentary, obese Americans are likelier to get sick, their insurance should be costlier. Avoiding higher prices will incent them to get fit. Letting older, unhealthier people underpay their fair share for health insurance swindles younger, healthier Americans who overpay their fair share for coverage.
McConnellCare should expand medical freedom: Give doctors and patients more options.
Liberals’ relentless quest for identical results across a wide, diverse population is yet another destructive unicorn hunt. As JFK explained: “It’s very hard in military or in personal life to assure complete equality. Life is unfair.”
• Rather than create a $50 billion insurance-industry bailout to subsidize pre-existing-condition coverage, we should direct the money to those patients. Either through HSA deposits or vouchers (“health stamps”), they would buy coverage that satisfies them.
• Come 2018, Medicaid should stop enrolling able-bodied, childless people whose incomes exceed pre-Obamacare eligibility limits. Thereafter, Medicaid patients could volunteer to receive their benefits as HSA deposits. Such funds could buy private plans, medication, etc. This would turn passive aid recipients into active health-care consumers who compare prices, evaluate quality, ask questions, and economize. This lowers medical costs.
• Whatever bonuses Washington pays states to enroll people in Medicaid must stop immediately. If anything, states should be offered incentives to steer Medicaid beneficiaries into private insurance.
• Senator Rand Paul, M.D. (R., Ky.), prescribes bifurcation: Moderate Republicans and Democrats should pass a bill that funds Medicaid. Conservative and moderate Republicans should adopt another measure that encompasses these market-oriented reforms.
While not ideal, this would be far better than a hard-Left, Republican-led RINO bill that delivers Repeal in Name Only. Otherwise, the GOP might abandon seven years of anti-Obamacare promises and enrage Republicans, independents, and even some Democrats who yearn for emancipation from Obamacare’s dungeon. These betrayed voters justifiably will torture Republican incumbents in November 2018.
But if Republican senators calm down and approve legislation along the lines proposed here — and then renovate and reduce taxes — Americans will rejoice. The GOP then would be poised to keep the House, win at least eight net Senate seats (among 25 that Democrats are defending), and secure a filibuster-proof Senate majority. With President Donald J. Trump wielding his signature pen, Republicans can spend two to six years implementing the conservative/free-market agenda. Democrats — like Palestinians at the U.N. — would be reduced to observer status.
That is the prize on which Republicans should keep their eyes.