OPINION:
Many ideas are being floated for changing Obamacare. For the most part, they fall into three camps: those urging some tinkering at the margins of the existing structure, those advocating total repeal, and those favoring repeal and replacement. By far, the best choice is none of the above. Instead, the mantra should be “repeal and redirect,” shaped along the following lines:
Start by agreeing on the end-vision, then work backwards to formulate the steps needed to transition from here to there over the next two years. As the transitional steps are rolled out, the end-vision should be kept in mind, lest ill-considered interim measures undermine realizing the ultimate goal.
The end-vision should include a significantly reduced role for the federal government. Our Constitution was designed to keep political power closer to home, with a federal government of limited powers, and with the states retaining sovereignty over the traditional “police power” for the health, safety, and welfare of the people. There is no legitimate constitutional basis for a centrally-planned national healthcare system.
Consistent with the Constitution’s design, Medicaid should be drastically altered, and then gradually phased out. To start, Medicaid funds should be block-granted to the states with no strings attached, save that the funds be used to enable the poor and needy to purchase health insurance and medical services and supplies as they choose. The federal government’s role in setting thousands of health-related prices should be ended.
The federal government’s practice of overtaxing the states’ peoples and businesses, then returning revenues to them via grants, should be phased out through reduced taxation, leaving government’s role to be decided and funded at the state level. (Once the Medicaid overhaul succeeds, let’s revisit Medicare.)
States then should allow private health insurers to offer coverage on a more rational and varied basis that better reflects what customers want. If customers returned to buying basic major medical coverage and paying out-of-pocket for routine procedures and most pharmaceuticals, premiums would plummet. Health savings accounts (tax-shielded accounts that reward individuals for shopping around for lower prices by letting them retain whatthey save) would better enable them to afford these everyday costs, and lead to significant reductions in hospitals’ and doctors’ charges. For the poor, vouchers (provided by States from block grants) to fund health savings accounts would enable them to reap the same benefits of shopping around for lower prices. Congress should act to protect health savings accounts.
Health insurers should be allowed to operate across state lines, the better to promote competition and maximize consumer choices. This elimination of interstate trade barriers would lead to higher quality and lower prices. (As for fostering competition among providers — hospitals, clinics, physicians, etc. — an overhaul of antitrust laws and enforcement is needed to prevent or undo excessive market concentration.)
The states should be allowed to function as the laboratories of experimentation that our founders envisioned. No one has a monopoly on good ideas, and often we simply cannot know how the best-laid plans will work in the real world. State officials should be at liberty to try out different approaches, and to adopt other states’ successful programs while avoiding their failures. Mistakes surely will be made along the way, but the states are far better positioned to correct errors than is the federal government — as the long-fought campaign to repeal the Obamacare disaster illustrates.
If all or most of these steps are implemented by Congress, and if the states react by working with providers and insurers while keeping the consumers’ best interests at heart, we will be amazed at how quickly market forces kick in to bring about huge improvements in the medical sector of our economy, with sellers succeeding by pleasing customers better. This is what happens when we embrace the morality of the market.
• Blaine Winship was the lead trial counsel for 26 states in their lawsuit challenging Obamacare. He is the author of “Moralnomics: The Moral Path to Prosperity” (Moralnomics Press).
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