Last month, Avik Roy, a senior fellow at the Manhattan Institute and an NR contributor, released a health-care-reform plan intended to push the entire American health-care system in a more free-market direction. Calls for repealing Obamacare, he argues, kind of miss the point: It’s a bad law that distorts the American health-care system and increases government spending, but the American health-care system is already dominated by government, and we need a plan to fix that.
Avik maintains liberalizing American health care can even be accomplished without getting rid of Obamacare, but by deregulating its exchanges, making health insurance more consumer-focused, and using the exchanges to privatize Medicaid and Medicare (this actually turns out to be a more conservative plan for Medicare than what Paul Ryan has proposed). His full plan is here and Agenda intern Callie Gable summarized it here.
This week, he presented the plan in New York — his pitch lays out what he thinks is wrong with the American health-care system (we’re already a single-payer country already, he points out) and what’s a politically plausible way to fix it. It’s well worth a watch:
Roy’s plan has conservative solutions to a number of problems that non-health-policy people are probably not even aware of: One of the main problems with Medicaid, for instance, is not just that it’s an overregulated single-payer benefit, but also that costs are split between the federal government (which pays for the majority of the costs and imposes rules on state) and the states (which pay the rest and actually administer it). Roy’s idea, which is taken quite seriously across the ideological spectrum, is to divide the program into its two main parts — give the federal government total responsibility for funding the normal health insurance Medicaid provides, while leave it to states to finance and provide long-term-care benefits (nursing home care, etc.) to the elderly and the disabled, a hugely expensive part of the program. Callie has an explanation of the advantages and drawbacks of that approach here.