Republicans may be scoring tactical victories in the current health care debate, but they are no closer to winning the long-term battle over the future of the nation’s medical system.
In 1994, Republicans defeated President Clinton’s health care proposal and took back Congress. But once that happened, the attitude was that they dodged a bullet, and for 15 years Republicans made no major effort to overhaul our over-regulated mess of a health insurance market. To the extent that they did act on health care, it was to pass the largest expansion of entitlements since the Great Society in the form of the Medicare prescription drug plan.
For the past several months, the Republican critiques of President Obama’s health care plans have centered on issues such as “death panels,” coverage of illegal immigrants, subsidies for abortion, and proposed Medicare cuts. Taken together, these criticisms have helped to weaken support for and build opposition to Democratic initiatives, but they have done nothing to advance an alternative vision for the health care system.
There’s a clear political rationale for the minority party wanting to avoid uniting around an alternative proposal that could be a huge target while having no real chance of passage. During the 2005 Social Security debate, Democrats merely hammered away at President Bush’s proposals rather than offer their own plan to address the crisis.
In lieu of uniting around a single alternative bill, it’s true that some Republicans have presented alternative proposals for reforming the nation’s health care system. But the problem is, when Republicans throw out catch phrases such as “consumer-based health care,” or propose changing the tax code and allowing individuals to purchase insurance across state lines, it doesn’t really mean anything to most people who don’t pay attention to the intricacies of health care policy. Thus, before Republicans will even be in a position to present alternate solutions, they have to familiarize Americans with an alternate narrative about the problems with the current health care system.
Democratic proposals are focused on getting more Americans health insurance, but about 90 percent of the country’s citizens are already covered. What really is at the center of the nation’s health care crisis is the sense of powerlessness that individuals feel when interacting with the convoluted U.S. medical system. And that’s a problem that affects nearly everybody, even if they have insurance and do not have a preexisting condition.
In 2008, 176 million people, or 58 percent of Americans, obtained health insurance through their employers, according to Census data. While these people are viewed as being among the lucky ones, the reality is that they don’t have much health care freedom. In general, workers have to enroll in whatever health care plan their employer offers them — or maybe if they’re really lucky, they’ll get to choose among several plans. Once enrolled in the plan, they have to pick a doctor from a list of physicians who participate in that given plan, and often they have to make that choice blindly. The reason is that even though Americans have numerous resources at their disposal to decide which DVD player to buy, which hotel to stay at, or which restaurant to eat dinner at, they don’t have as many ways to find out which doctor is best for them.
In addition to the lack of choice, those with employer-based health insurance face the prospect of losing health coverage and doctors they are happy with if they switch jobs, and losing coverage altogether if they are let go.
Those who do not have health insurance through their employers or do not qualify for government health coverage are forced to navigate the individual insurance market. Not only do they start off at a disadvantage because they do not get the same tax benefits as they would if they obtained coverage through their employers, but they have only a limited amount of choices.
Most states place onerous regulations on insurance policies that require them to cover certain benefits government deems essential. There are over 2,000 of these benefits nationwide, which drive up the cost of health coverage by 20 percent to 50 percent, according to the Council for Affordable Health Insurance. That means that young and healthy people who may want basic health insurance plans with lower monthly premiums are forced by government to either buy a plan with a price tag that far exceeds their health care expenditures, or go without insurance, as many do.
Thus, the way the health care system functions in this country is completely different from the way any other part of the economy functions. Everywhere else, American consumers face a dizzying array of choices and they have the freedom to buy what they want, and the ability to shop around for the best price. But when it comes to health insurance, people can’t buy the coverage that they want, but the coverage that the government says they need.
Americans should have a health care system that allows them to exercise the same freedoms that they do in other parts of the economy. A system in which they could choose insurance policies that best fit their needs, take their policies with them from job to job, and hang on to them when they are between jobs.
Such a system would not only have benefits for the individual, but would remedy many of the problems facing the nation as a whole. If individuals had more control over their health care dollars, then they’d have more of an incentive to shop around for the best price for medical services and less reason to abuse the system by seeking unnecessary care. And while under the current system insurers expect to lose their customers every few years as they change jobs, in a free system insurers could potentially maintain somebody’s business for life. If that were the case, then suddenly insurers would have more of an interest in providing incentives to individuals to make healthier lifestyle choices such as losing weight and quitting smoking — the type of preventive measures that would help ease the strain on our health care system.
Only if Americans understand how much government meddling there is in the health care system and how an alternative system could function can Republicans begin to make the case for ideas such as allowing Americans to purchase insurance across state lines and ending the discrimination in the tax code against individuals who buy health insurance on their own.
While it’s unrealistic to believe that any such ideas could make it into any of the current Democratic bills, Republicans should take advantage of this time when the whole nation is focused on the health care debate to lay out a different vision. If they don’t seize this opportunity, they will continually be playing defense on the most important domestic issue of our time.