September 10, 2013

Obamacare was sold on the promise of affordable, universal care with no increase in the debt. Oh, and you were going to keep your insurance. It is none of these things.

House Budget Committee Chairman Rep. Paul Ryan, R-Wis. (Carolyn Kaster/Associated Press)
House Budget Committee Chairman Rep. Paul Ryan (R-Wis.) (Carolyn Kaster/Associated Press)

Even Obamacare’s most ardent defenders (who actually bought the Congressional Budget Office hooey about the impact on the debt) are forced to recognize that Obamacare will leave 30 million Americans uncovered. Considering the taxes, increase in debt, dislocation and cost increases inflicted on the American people, it seems we are getting very little bang for billions of bucks.

This should also stir Republicans to present their own plan. It’s never been a better time.

There are some mechanisms that would approximate the reach of Obamacare, but likely aren’t acceptable either to the GOP or the public. These would include scraping the existing employer-provided health-care insurance system in favor of a tax credit for all Americans. Nevertheless, something that costs a whole lot less, doesn’t include massive tax hikes or increase the debt, and allows people to keep their existing coverage would likely please most Americans, even if it left, say, 45 million or so uninsured. Obamacare’s unkept promises and unworkability have ironically primed the pump for a conservative health-care reform plan.

Luckily, there are a few of them floating around, some for 30 years or so. James Capretta of the Ethics and Public Policy Center and the American Enterprise Institute (and former associate director of the Office of Management and Budget) has a multi-pronged approach:

A market-based reform agenda could deliver much more positive results than a federally managed approach like Obamacare. Seven pillars that would support such an effective replacement program are: to build a “defined contribution” approach to the public financing of health care, encourage personal responsibility and mandate continuous coverage protection, establish a genuine partnership with the states, address the tax treatment of employer-sponsored plans, overhaul Medicaid, initiate premium-support reform of Medicare, and, finally, offset all new costs through spending cuts. If successful, this new program could permanently change the national political conversation over health care policy.

For example, without an individual mandate the federal government can still promise that “so long as people remain continuously insured with at least catastrophic insurance, they should never be forced to pay high premiums solely because they develop a costly health condition.”

With a tax-credit system to ensure even wider coverage, Capretta suggests: “States would be responsible for designating several insurance plans as default options to which persons who are eligible for a refundable tax credit would be assigned (on a random basis) if they failed to sign up for coverage on their own. . . The default concept is simply a way to approximate universal enrollment in insurance in a voluntary, consumer-driven marketplace.”

Unlike the president, conservatives should be candid that these market-based solutions aren’t “free.” They do, however, cost a whole lot less than Obamacare. (“It is likely that federal expenses would rise by approximately $30 to $40 billion per year—well below the $200 billion (and rising) annual expense of Obamacare when fully implemented.”

This will not satisfy those who think there is no role for the federal government in health care, nor will it soothe liberal critics who insist that the federal government must micromanage Medicaid (even though states could do it more cost efficiently) or that we give an open-ended commitment to Medicare. But these ideological extremes are not politically or fiscally acceptable any longer.

The good news is that Obamacare’s colossal failures (we haven’t even gotten to the implementation problems) have opened the door to conservative reform. Now it’s essential that lawmakers champion an alternative, introduce it and at the very least pass it through the House. Then the American people will have a real choice they can make in the 2014 and 2016 elections. Do they want Obamacare or something that gives them a lot more value for taxpayers’ dollars?

Jennifer Rubin writes the Right Turn blog for The Post, offering reported opinion from a conservative perspective.