Kudos to David Frum for bringing to light a different - for conservatives, that is - perspective on a way too familiar
argument: namely how to best deal with the high-rising cost
of medical care. In a recent piece he cites fellow conservative Bob Paterson, who
believes that the best replacement for Obamacare would be a system like
Britain's National Health Service. Paterson writes,
First, congressionally charter Blue Cross-Blue Shield as
a monopoly to provide basic coverage to all Americans, except retirees. And
grant the regulated nonprofit authority to impose payer-fee schedules on
providers of routine care and services, much as Medicare does. A utility-style
Blue Cross-Blue Shield covering all working-age Americans and their dependents
would offer enormous administrative economies of scale and an insurance pool of
unprecedented size. By trumping state regulations, the plan would be relieved
from paying for luxuries like aromatherapy, Viagra, sex-change operations, hair
implants, birth control, or elective abortion. Nothing would preclude other
carriers from selling supplemental insurance for medical non-necessities,
purchased by individuals at after-tax rates.
Jointly funded by a modest payroll tax and shale-oil
severance fees, this utility would not only replace all nonsupplemental
health-care plans, but also Obamacare, state exchanges, much of Medicaid, and
the State Children's Health Insurance Plan. Medicare - and Medicaid for the
severely disabled - would remain in place.
Next, Republicans should transform the healthcare debate
by championing strategic cures to make Americans healthier and as disease-free
as possible. As the polio vaccine did in the 1950s, we can bend the
long-term cost via technological breakthroughs.
The thrust of Paterson's argument is that it is stupid for
Republicans to continue their efforts to repeal the healthcare law; it's here
to stay. Instead they should be working to improve it, a point Frum made back
in 2009 when Democrats were supposedly "ramming" it down the throats
of the country.
What I find interesting and mildly amusing isn't so much
Paterson's rebuke of his fellow conservatives' failed strategy, but rather the
solution he comes up with to replace Obamacare. In case you missed it,
what Paterson is calling for is a kind of Medicare for All, which, if I'm not
mistaken, was what progressives were calling for back in 2009.
To recap, Obama, as you might recall, anticipated he didn't
have the votes to get a single payer or public option through Congress, so he
opted for a plan that mirrored Mitt Romney's Massachusetts healthcare law. The
employer mandate had been a conservative idea as early as the late 1980s, when
it was heralded by the Heritage Foundation. Bob Dole, in 1993, approached then
President Bill Clinton with a proposal to pass a similar plan, claiming he
could deliver the votes needed, but Clinton turned him down. The rest was
history. Obama, perhaps sensing a repeat of that history, jumped at the
chance to get what he could through, even though the enforcement mechanism was highly unpopular.
And that has been the sticking point for conservatives and
liberals alike. The Affordable Care Act's employer mandate has been an
albatross from day one. Rightly or wrongly, it unfairly puts a burden on
smaller businesses who must now offer health insurance and while it does
contain some cost-saving measures, it still does not do enough to lower overall
costs. It also doesn't tackle the number one issue behind the rise in
healthcare costs: the fee for service model. If anything, it left it pretty
much intact. The insurance industry still drives the bus; only now it has more
fuel, courtesy of the 30 million more Americans who must now buy into a
hopelessly corrupt system.
Medicare for All would've killed three birds with one stone.
First, it would've eliminated fee for service altogether. Doctors would know
upfront what they were getting paid as compensation for their care and
treatment. Second, it would've removed from all employers - big and small - the
responsibility for having to provide health insurance for their employees.
Imagine how much more profitable corporate America could be just by eliminating
that one nagging issue. And third, it would've stabilized a badly hemorrhaging
Medicare system that is less than a decade away from going bankrupt.
The problem with Medicare isn't that it's an entitlement
program; it's that the people who use it - seniors - get sick more often than
younger people. By expanding the roles of Medicare to the entire population,
the costs of the program are spread out far more evenly. Think of it this way.
How long would an insurance company last if it could only insure people 65 and
older? That's the current problem with Medicare and if it isn't dealt with
successfully, any bandage that gets applied to it will be temporary at best.
The Obama Administration can hardly be faulted for getting
the best deal available to it, especially when so many prior administrations
had tried and failed. But while it is an incredible accomplishment, given the resistance by its opponents, it's time to admit the obvious: the Affordable Care Act is flawed. It needs to be fixed, not scrapped. It's
harshest critics on the right and left should work together to improve it. It's
refreshing to see that at least one conservative has seen the light and had the
courage to say the unthinkable. Let's hope that more step up to the plate.
Link:
http://www.thedailybeast.com/articles/2013/04/03/one-social-conservative-s-alternative-to-obamacare.html
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