The Corner

A New Study of the Conservative Alternatives to Obamacare, and What’s Missing From It

One of my favorite health-care analysts, the Washington Examiner’s Philip Klein, has a new e-book, “Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care,” that sheds some light on what conservatives are thinking about how to replace Obamacare.

As Klein explains, there are many alternatives floating out there. The main issue differentiating them, he suggests, is how much their proponents favor the government’s role in providing health insurance. He’s right, and I think it’s unfortunate.

Of course it’s always important to debate what the appropriate role of government in the provision of anything should be — you know where I end up – focusing exclusively on the provision of health coverage is distracting us from a more important health-care goal: How can we produce better health for more people at lower cost, year after year?

Health-care coverage, simply, is different from health care. While introducing more consumer choices and competition among health-care suppliers, for instance, certainly will affect health-care prices, nothing will have as radical an impact on prices as would the kinds of revolutionary innovation in the health-care industry that we’ve seen in other fields, such as information technology.

So how do achieve that type of revolutionary innovation? My colleague Robert Graboyes makes the case that we have to free the health-care supply from the many constraints imposed by federal and state governments (blue and red both) and the special interests they serve. 

This demands, as he puts it, that health-care policymakers discard their “Fortress” mentality and adopt a “Frontier” attitude that tolerates calculated risks and welcomes competition from diverse practitioners and disciplines. For more on what that will mean in practice, I encourage you to check out his study on the issue, “Fortress and Frontier in American Health Care.”

If you don’t have time for the 67-page study, he’s also got a four-page summary and an op-ed. Or check out this great visual summary of the key themes of his work:

His take in the video on Frontier vs. Fortress:

The Fortress has two goals. First is to imagine all the terrible things that might go wrong in health care and prevent any them from happening. Second is to shield those in the medical industry—doctors, hospitals, insurers, drug and device manufacturers—from potential competitors who might threaten their turf.

The Frontier is different: It understands that big quality improvements and cost reductions don’t come without accepting some risk. And it understands that real innovation won’t occur unless doctors and hospitals face new competitors like IBM faced Apple and Western Electric faced BlackBerry.

While Left and Right think of themselves as radically different, both are deep in the Fortress. 

The bottom line: To fix American health care, we need a new way of thinking about it, a new focus away from the demand side – away from the provision of health insurance toward the supply side of health care.

The stakes are high: Bringing revolutionary innovation to this industry could mean not just bending the health care cost curve but breaking it to bits – making the need for health insurance much less important if not moot in many cases. Conservatives and libertarians are always more convincing when they talk about creating goods than when they talk about redistributing them — let’s apply that to health care.


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