The landslide Republican victory, in taking the House and electing some strong conservatives to the Senate, can be interpreted as a mandate to rein in government spending, and specifically to repeal ObamaCare, as these issues were clearly behind the large turnout. There is still a very real possibility the Supreme Court will find the “individual mandate” to buy private insurance unconstitutional. If this provision is thrown out, it’s hard to see how the law survives, since the mandate is needed to finance it.
Now is an excellent time to construct a conservative alternative vision for true reform of our health care delivery system. Since most current problems with the health care system stem from government, a conservative plan should seek to reduce its role.
It goes without saying that the Patient Protection and Affordable Care Act must be repealed since, like all the laws passed by this administration, it does precisely the opposite of what its name suggests. By massively increasing the health care bureaucracy at the expense of actual providers of care, it will make care harder to access and more expensive. Many physicians will take early retirement and the already great physician shortage will be exacerbated.
The law is too large and complex to waste time foraging for items to salvage. There is a great risk of leaving behind hidden mandates and rules that will be harmful. Better to scrap the whole thing. With Democrat Senators running scared for their jobs in 2012, it is conceivable the Senate would also vote for repeal (Harry Reid notwithstanding). But not even the most generous view of Barack Obama’s ideological flexibility has him signing a repeal bill, and a veto override is out of the question for now.
It may be possible, however, to enact affirmative measures that make ObamaCare irrelevant. Here are some common sense, free market proposals, many of which were proposed and discussed, but ignored by the President and the Congressional leadership in the run-up to passage of ObamaCare.
1. Transfer the tax deduction for health care spending from employers to individuals. This would end the absurdity of purchasing health insurance at the "company store," a practice that limits individual choice and liberty, nourishes a sense of dependency, and promotes overuse of care. This policy, an accident of WW II wage and price controls, was the “original sin” in health care financing; doing away with it would empower consumers to shop for the best plan for their families, which will lower premiums.
2. Remove barriers to the interstate sale of health insurance. There is broad agreement on this proposition. It would increase choice and competition between insurers and drive down premiums by effectively ending state mandates that drive them up.
3. Deregulate and allow greater contributions to Health Savings Accounts. These fabulous tax shelters give individuals more control over their health spending, and, coupled with an inexpensive policy to cover catastrophic illness (i.e., true insurance), are all most people need. By returning most health care purchasing decisions to consumers, spending will immediately be slowed and prices curbed. This is the conservative, free market, already tested and proven way to "bend the cost curve down."
4. Follow the recommendations of the bipartisan Breaux Commission and give Medicare beneficiaries a means-tested stipend to buy private insurance. This solution came during the Clinton era but was too free-market to pass muster with Bill and Hillary. With Medicare moments from insolvency, there should again be a bipartisan consensus to reform this behemoth.
5. Transfer (gradually) all Medicaid responsibility to the states. Federal support for Medicaid allows much greater spending than would otherwise occur. It forces frugal states to subsidize lavish coverage in New York, California, and elsewhere. States should have complete freedom to organize their Medicaid systems along their own priorities, in exchange for losing, over perhaps five years, the federal subsidy. This would encourage states to find innovative ways of providing health insurance for the poor, such as individual health accounts, or subsidies to buy private insurance.
The latter two points would allow the mammoth Center for Medicare and Medicaid Services to be mothballed, though Medicare could retain a role as insurer of last resort for those with pre-existing, expensive, chronic diseases.
6. Institute a "loser pays" system for medical malpractice to cut frivolous lawsuits. The ability to launch a lawsuit (and this applies beyond medical malpractice) with minimal financial risk is the reason behind the explosion of malpractice litigation, with all the associated costs. Tort reform at the federal level would require the Senate to override the trial lawyers’ veto, which could be a problem. This reform should be pushed at the state level.
7. Finally, for true patient protection, let's propose a constitutional amendment to guarantee the individual's right to privately contract for medical care. This will eliminate for all time the threat to the private practice of medicine and assure that, no matter what system is in place, patients will always be allowed to spend their own money on care.
The above points are clear, simple and practical solutions. They empower the individual and greatly reduce malignant government influence and unburden the taxpayer. It is the conservative way forward on health care.
Richard Amerling, MD is a nephrologist practicing in New York City. He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).