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.