The GOP Needs to Play Offense on Health Care
Democrats running for president are determined to make the 2020 election a referendum on single-payer health care. My advice: Bring it on. This is a fight President Trump and the GOP should welcome.
But in order to win, the GOP has to come to terms with its past failures, reflect on its limited successes, and chart a new course. We have to boldly define what we are for, not just what we are against, and win the hearts and minds – and trust – of voters.
For nearly 30 years the GOP has done a better job of documenting the left’s utopian excess and folly than uniting around and promoting our vision for patient-centered health reform. Republicans won big after the backlash of Hillarycare in 1994 and then Obamacare in 2010, but we paid a heavy price for not delivering on reform in 2018.
The problem is not that Republicans have not offered ideas and solutions. I introduced a version of what are now known as Health Savings Accounts in 1991. In 2003, the GOP created Medicare Advantage, which uses market forces to offer seniors choice and affordable, quality coverage. During the Obamacare fight, several GOP lawmakers, including doctors Tom Price and Tom Coburn, offered serious Obamacare alternatives. Yet, speaking as a former member of the GOP leadership in Congress and as a presidential candidate, the painful reality is our party has not done the work required to develop a consensus.
This failure was on full display in 2017. Even though we had nearly a decade to prepare our Obamacare alternative, the House struggled to pass a “repeal and replace” bill and it was derailed in the Senate when John McCain voted no. But the vote should not have been close enough for one senator to make a difference.
The lesson for Republicans is that the left’s failure and overreach do not guarantee conservative success. Fortunately, President Trump has promised to make the GOP the “party of health care” and will release his own plan in the coming weeks that will complement the steps his administration has already taken to empower consumers.
A plan already exists for the president to consider called the Health Care Choices proposal. This plan, which creates a patient-centered system that delivers more choices, better access, improved quality and lower prices, was developed by a group of grassroots leaders and policy experts. The plan is in part inspired by the strategy and tactics that helped us enact welfare reform in the 1990s. Rather than offering a Republican version of a centralized, command and control, one-size-fits-all solution, the essence of our plan is to shift the balance of power from Washington to patients through the states.
The center of gravity in our health care system today is not doctors and patients but government and anti-competitive monopolies that defend a costly status quo, which limits choice, drives up cost and undermines quality. A recent report from the American Enterprise Institute estimates that the share of health spending influenced by the government is 77%. Democrats want to tilt the scales all the way to 100% while we want to move toward a patient-centered system.
Our plan would take a powerful step towards this goal by eliminating Obamacare’s failed entitlement spending scheme and converting Obamacare subsidies into grants to improve access to private coverage, lower premiums and protect patients with pre-existing conditions. Today, taxpayer money flows to insurance companies, which get more money every time they raise prices. That’s a recipe for higher costs and lower value.
Under our plan, everyone who gets a subsidy could use it for coverage of his or her choice. States would get new flexibility to heal their broken private markets. And unlike Obamacare, our plan actually dedicates taxpayer subsidy money to making sure those who are sick get coverage.
We also repeal the employer mandate while expanding HSAs, increasing the number of shoppers from 22 million to 84 million. Doing so would create a new army of consumers that would help lower costs by driving competition and price transparency.
This plan builds on existing successes today. Innovative state leaders aren’t waiting on a polarized Washington to produce an unlikely bipartisan consensus. The Obamacare law itself allows states to innovate and offer more affordable care through waivers from the law’s onerous one-size-fits-all mandates. Seven states including Maine, Alaska, Oregon, Wisconsin, and Iowa have used these waivers and seen costs fall and enrollment rise – all while using tools that better protect people with pre-existing conditions.
And, thanks to new encouragement from the Trump administration, other states are going yet further. Georgia, for example, is considering a proposal to create a stronger and more durable safety net than Obamacare through a reinsurance program that absorbs the costs of the most expensive patients without driving up costs for everyone. The proposal also facilitates people’s ability to choose to work directly with doctors through a direct primary care model as well as traditional insurance.
States are already taking the lead by using waivers to let the choice genie out of the bottle. The federal government will have a difficult time rolling back these reforms.
As Republicans prepare for 2020, we have to talk about what we are for, not just what we are against. It is true that “Medicare for All” would effectively ban private insurance and kick 158 million people off their plans. But documenting the folly of the Democrats’ rebrand of single-payer won’t be enough to rally the country behind patient-centered reform. We have to offer our vision and win people to our side.
For decades, progressives have been fighting to win the next generation while we’ve been fighting not to lose the next election. The left has been telling a story. We’ve been reading from the index. And we wonder why people don’t understand what we’re talking about.
Our story is about freedom, choice and human dignity. We’re striving to restore the patient-physician relationship and facilitate the care of every patient. Polls show Americans care about lowering health care costs and choice. They want to be in the driver’s seat for their health care decisions – not give that power away to big business or big government.
That’s why choice is the Achilles’ heel of single-payer. There is no way to get to single-payer without resorting to coercion and control and that, in the end, means harshly limiting health care choices and options for those whom we want most to care for and protect.
Republicans have not only the better story, but also the better policy. We have no reason not to be bold in 2020.