A Health Care Reform Agenda for the 112th Congress
by John Wright on December 4, 2010 at 3:35 PM
If the repeal of ObamaCare somehow gets past a filibuster in the Senate, it is certain to be vetoed by Obama.
What then? To convince the electorate that the GOP is indeed prepared to govern well, Congressional Republicans must develop legislation, embodying conservative, market-driven, limited government principles, which effectively addresses the public’s concerns about our dysfunctional health care system.
There is no shortage of chalkboard solutions that meet that challenge. Most, however, include measures that influential segments of the electorate, including many voters at the heart of the coalition that restored the GOP to majority status in the House, will be skeptical of, if not overtly hostile to.
Numerous analysts, for instance, urge the repeal of the employer health care tax deduction, but as the outcry that surrounded the McCain campaign’s proposal to end this deduction demonstrated, voters often struggle to understand how an apparent increase in taxes on health care will result in reduced costs. And elderly voters, who favored the GOP by a 21% margin in November, will be wary of any changes to Medicare.
Other policy initiatives, however, like malpractice reform, insurance market reform, and expanded Health Savings Accounts, are politically popular, make good sense as policy, and perhaps most importantly, will create immediate downward movement in health care costs. The resulting decline in costs, moreover, will create a tangible improvement in the household finances of voters of every stripe, while also helping to increase access for those who struggle to obtain necessary care, and relieving the pressures on the Federal budget that decades of skyrocketing costs have generated.
By making the passage of these proposals their priority during the 112th Congress, House Republicans will position themselves to benefit immensely over both the short- and long-term. Firstly, they will force difficult choices on Senate Democrats and the White House. Opposing popular policy initiatives does self-evident harm, which Democrats will almost certainly choose to avoid. But in this case, acceding to their passage may well be the more dangerous political path for Dems.
Doing so will undermine their claims that they made good-faith efforts to incorporate GOP proposals in devising ObamaCare; allow the GOP to portray itself as the driving force behind a reform agenda that delivers observable, real-world results; immunize House Republicans from Democratic attempts to tag them as a “Do Nothing Congress”; and, in the case of malpractice reform, put Dems at odds with trial lawyers, whose extensive campaign contributions are a potent resource for Democratic campaign efforts.
The most important outcome, however, is that passing these reforms will build voter confidence that the path to a health care system which provides affordable, quality care, leads through free markets. Compelling evidence will emerge that private sector entities –insurance companies, doctors in private practice, for-profit hospitals – can be the building blocks of a superior health care system when freed from perverse incentives and market-distorting effects of interventionist government policies. And a mandate for the more sweeping, market-friendly policy initiatives necessary to make American health care the envy of the world can be built on the foundation of incremental reforms, whose implementation is well within the reach of the next Congress, despite the fact that opponents of market-based policies hold the Senate and the Presidency.
This is not to say that Republicans should not pursue other health care goals, as well. Pruning back ObamaCare by defunding key provisions and subjecting the implementation of others to Congressional Review Act scrutiny makes good sense as policy and politics, especially such unpopular and destructive provisions as the insurance purchase mandate, and the required reporting of all business transactions exceeding $600.
But the damage Obamacare will inflict, due to its attenuated implementation, lies several years down the road, and preventing said damage from occurring, while desirable in the abstract, yields little in the way of short term benefits, political or otherwise. Thus, to the degree that the GOP’s political capital is limited, it will be better spent on measures that will create immediate positive impact in the lives of voters, strengthen their perceptions of the GOP as a party competent to rule, and fortify their sense that free markets and limited governments provide the best answers to the questions that vex the body politic.
While working towards those ends, another consideration with both political and philosophical ramifications should be attended to. In crafting reform legislation, lawmakers shouldn’t assume that reform must be imposed on the states from above. States such as Mississippi and Texas have implemented effective tort reform policies in the last decade, and 60% or more of voters regularly tell pollsters that they favor caps on jury awards in health care malpractice lawsuits. Utah has recently designed a fascinatingly innovative approach to insurance market reform. There is clearly a will to experiment in the laboratories of democracy.
And in seizing control of 29 Governor’s mansions and 26 state legislatures, many talented young conservative politicians, eager to restore the GOP to its rightful place as the party of limited government and fiscal sanity, have risen to places of power, and stand ready to flex their newfound policy-making muscle. Thus Congressional Republicans should, where possible, eschew the Zeus-hurling-thunderbolts-from-Olympus model, and instead explore opportunities to scale back federal oversight of state health care systems and policies, create space for the GOP’s next generation of leaders to emerge, and begin restoring American government to its intended Constitutional balance between Federal and state power.
A final caution: We must neither overreach nor underperform. It is manifestly true that the rise of the Tea Party movement, and the accompanying backlash against Big Government, indicates that the electorate is more receptive, at a broadly philosophical level, to a conservative, market-driven, limited government approach to health care reform – and indeed, to a radical revision of the New Deal entitlement state - than at any time in recent memory.
But maximizing the potential of this moment will require more than a majority in the House of Representatives. To reharmonize American life with the music of its Founding, we must control the orchestra pit and the conductor’s baton, not just the brass and woodwinds.
Our eyes must ever be on 2012, and not just winning the Senate and the White House. We must win with a mandate for sweeping reform, and bring our organizations, our committees, our campaigns, and our legislative agendas into alignment with an airtight strategy for winning that mandate.
Regarding the health care components of such a strategy, see above.