The Magazine

Two Aspirin and Call Us in 2008

The GOP health care consensus.

Oct 1, 2007, Vol. 13, No. 03 • By YUVAL LEVIN
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Individually purchased health care coverage would also create more cost-conscious consumers. Galloping growth in health care costs is a major source of the public's anxiety about coverage. The Bush administration has begun to use the lever of Medicare payments to force physicians and hospitals to make prices publicly known, and Republicans in Congress and on the campaign trail have pushed for greater openness about costs too. Together with the long-standing campaign for Health Savings Accounts, this begins to point the way toward a more consumer-driven health care market. Health care is not quite like any other commodity (nor should it be), but it can be subjected to some market pressures to control costs and empower patients.

Finally, Republicans have also proposed allowing states more latitude in using Medicaid dollars that now pay for "uncompensated care" (which mostly covers care for the uninsured who do not directly qualify for Medicare) to provide subsidies for the uninsured to help them buy their own private coverage. As governor of Massachusetts, Mitt Romney used such an approach. But rather than a national version of his state's plan, in August Romney proposed giving each state the ability to design its own approach to the problem. (In the same speech, he also lined up behind a tax reform proposal and consumer-driven health care.) The Massachusetts model, he suggested, could help other states. But for the federal government, his preferred solution is much like Bush's and, by all indications so far, like those of all the prominent Republican presidential candidates. It is the new GOP health care consensus.

This mix of proposals is not without its own problems. Medicaid flexibility, for instance, has tended to encourage state irresponsibility with federal dollars in the past. And consumer-driven health care, if carried too far too fast, can increase the an-xiety of families by forcing them to make unfamiliar choices. But on the whole, Republicans have put forward serious yet modest proposals that address voters' concerns about the stability and portability of their insurance coverage and help the uninsured while keeping in place a private insurance system that works quite well for the great majority of Americans.

The overreaching of the Democrats may hand Republicans an unexpected opportunity on health care reform. Both parties are seeking to address the concerns of the middle class and uninsured, but the Republican approach builds on what most middle-class voters like about the current system (its relative freedom, lack of waiting, and decent quality), while the Democratic approach builds on what they don't like (bureaucracy and loss of control over health decisions).

Some Democrats are clearly aware of their vulnerability. In rolling out her health care proposal last week, Hillary Clinton was notably defensive. "This is not government-run," she said in her two speeches announcing the plan. "There will be no new bureaucracy." But her plan calls for a new federal individual health insurance mandate (which will require an entirely new national regulatory structure for coverage) and includes a new public government-run insurance program on its menu of coverage options. It points precisely to bureaucracy and government-run health insurance. The lady doth protest too much.

A savvy Republican candidate would talk about two sets of health care problems: The first are the problems of the system we have, and the second are the prospects of centralized, bureaucratic, government-managed health care, which the Democrats support--slowly dismantling our health care system and replacing it with a huge bureaucracy from the people who brought you the post office and the DMV.

The new Republican approach to health care would address both problems through targeted reforms that control costs, give more people access to private insurance, improve the stability and portability of coverage, and increasingly put insurance decisions in the hands of individuals and families, where they belong. This is the platform the Republicans have long needed.

Yuval Levin is a fellow at the Ethics and Public Policy Center and senior editor at the New Atlantis magazine.