I’m not generally in the business of giving advice to the Republican Party, but when you see people suffering with no self-awareness or plausible path to recovery, an intervention is in order.
Since the election and their subsequent fiscal-cliff and debt-ceiling retreats, Republicans have been flailing, even as “rising stars” such as Bobby Jindal and Marco Rubio offer messaging tweaks rather than policy adjustments. So let me reveal a sure-fire way for a Republican governor to grab the national spotlight, earn a reputation as a problem-solving innovator and help the GOP seize the political center in ways that honor conservative values.
All that Republican governor has to do is this: Ask the Obama administration for a waiver to Obamacare that lets him or her implement universal catastrophic health coverage in his or her state.
Let me explain why this call to “mend, not end” Obamacare would be great policy and better politics for Republicans (and good for the country as well).
First, let’s look at how the policy would work. Catastrophic coverage means that after a certain deductible, all medical expenses would be covered by insurance. Usually when conservatives peddle such high-deductible plans they make a fatal mistake: They fail to limit out-of-pocket expenses to some reasonable share of family income. A $5,000 deductible for a family earning $22,000 doesn’t make sense. So this GOP plan would define “catastrophic” relative to income.
The other typical flaw with catastrophic plans is that people don’t get the preventive care they need. So you need to make sure everyone can afford such care – either via pre-funded health savings accounts for those with modest incomes or by subsidizing some version of the emerging “fitness club” model of primary and preventive care, in which members pay, say, $65 a month for access to these services (with no insurer involved at all).
This brand of reform has a solid Republican pedigree. Former Treasury secretary Paul O’Neill pushed a version of universal catastrophic coverage when he worked at the Office of Management and Budget in the 1970s. A smart update of the concept was laid out by Dana Goldman and Kip Hagopian in the fall 2012 issue of National Affairs (the “it” journal edited by Yuval Levin for conservative wonks).
Our GOP leader would ask Health and Human Services for permission to consolidate all federal monies now coming to his or her state for nonelderly health care – including Medicaid, the new Obamacare subsidies and, ideally, the cost of the current tax subsidy for employer-provided care – to fund the universal catastrophic plan. (Regulations say such waivers can’t be sought until 2017, but in Washington everything’s negotiable.)
The GOP plan would also replace today’s malpractice litigation lottery with a system that protects doctors from liability so long as they’ve followed evidence-based best practices. This would put an end to the “defensive medicine” that runs up costs — a common-sense reform that Democrats reject as a sop to the trial lawyers who fund their campaigns.
At one stroke here’s what this policy would accomplish. Every person in the state would have true health security; never again would a family be at risk of financial ruin due to illness. This outflanks Obamacare to the left, because, despite frequent White House hints to the contrary, Obamacare will still leave 20 million to 30 million Americans uncovered when the dust clears.
The GOP plan would achieve this goal more cost effectively than Obamacare would, because it includes more incentives for cost-conscious purchasing of routine services (while still assuring full protection in case of serious illness).
It positions Republicans – for the first time in how long? – as addressing a major problem facing average Americans. And it does so in ways that confound the usual categories — covering everyone is “lefty,” but doing it via catastrophic is “righty” – showing how pragmatic a Republican policy can be.
The malpractice fix exposes a Democratic vulnerability. And when our GOP governor insists that every public official in the state carry the same coverage as citizens do (so there’s no question of “two-tier care”), you have, by my count, a “win-win-win-win-win” policy.
“Win-win” would be enough to pick the GOP up off the floor. “Win quintupled” starts to look like a road to salvation.
An initiative like this would be good for the country because we’re all better off if our two major parties offer serious competing ways to solve real problems. It helps no one but the Democratic party when crazed Republicans moan about “freedom” and “big government” without offering ideas that might improve health, schools, housing, jobs, wages, upward mobility and more.
All that remains is to pick the governor who can carry this off. New Jersey’s Chris Christie, Ohio’s John Kasich and Michigan’s Rick Snyder all have pluses (and minuses). But my choice is Susana Martinez of New Mexico — a state where one in five people lacks health coverage (a rate topped only by Texas, Nevada and Louisiana). Martinez is feisty, smart and down-to-earth, and as far from the Boehner-Cantor-Ryan Beltway crowd as you can get.
Oh, and her last name is “Martinez.” The Martinez plan could showcase the idea of states as laboratories (another conservative “win”) and prove a potential model for the nation.
No need to thank me, GOP. When you see people in pain, it’s a privilege to be able to help.