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The Replacement

After Obamacare is repealed, Republicans should offer sensible improvements to the health care system

Feb 14, 2011, Vol. 16, No. 21 • By JEFFREY H. ANDERSON
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When discussing Obamacare during his State of the Union address, President Obama told congressional Republicans, “I am eager to work with you” in finding ways “to improve this law.” But Obamacare has never lent itself to meaningful compromise or substantial revision, as its supporters have been the first to note. Shortly before last year’s health summit, Health and Human Services Secretary Kathleen Sebelius discouraged much tinkering, explaining that the complex interconnectedness of Obamacare’s component parts prohibited it. Sebelius said, “Pieces of the puzzle are necessarily tied together if you have a comprehensive approach.” In other words, Obamacare’s “comprehensive approach” requires one of two results: comprehensive acceptance or comprehensive repeal.

The Replacement

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In his closing statement at that health summit, Obama said that if Republicans couldn’t get on board with his approach, “then I think we’ve got to go ahead and make some decisions, and then that’s what elections are for.” 

Indeed. And now, after an election in which the Republicans rode a wave of anti-Obamacare sentiment to their largest House gains since before the release of Gone with the Wind, they aren’t about to accept Obama-care as a permanent fixture of American life—and neither is the citizenry that elected them. If an architect gives you a horrible plan for a house you didn’t ask for, can’t afford, and don’t want to live in, you don’t work with the architect to change the color of the paint or modify the placement of a closet—especially when the foundation hasn’t yet been poured. Rather, you fire the architect and get to work on replacement plans for something far more livable and affordable. 

The American people couldn’t fire the principal architect in November, but they did the next best thing. They canned members of his party and empowered House Republicans who, of course, have now passed a full repeal bill—by a 56-vote margin, 8 times as large as the 7-vote margin by which Obamacare squeaked through the previous Democratic House. 

But while Americans want repeal, they don’t just want repeal. And thus the House Republicans are now confronted with their greatest challenge—and opportunity—in the whole span of the health care debate. They need to show the American people that the choice is not between Obamacare and nothing. They need to provide a meaningful, sensible alternative to Obamacare’s comprehensive failings. 

The American people want three main things out of health care reform: They want health costs to drop. They want the number of people with insurance to rise. And they want to make sure that people with expensive preexisting conditions aren’t going without medical care. Republicans can deliver on all three counts. 

There are also many things that Americans don’t want out of health care reform: the loss of their health care plans; reductions in medical innovation; a decline in the quality of care; massive increases in federal spending and debt; the government injecting itself into the doctor-patient relationship; eventual federal rationing. Republicans can avoid following in Obamacare’s ominous footsteps on each of these counts. 

The Republican plan should emphasize three relatively simple things: lowering health costs, stopping the tax code from discriminating against the uninsured, and funding state-run community (“high-risk”) pools. A GOP plan that did these three things would be scored by the Congressional Budget Office (CBO) as cutting costs and adding on the order of 10 million people to the ranks of the newly insured.

(1) Lowering health costs. The health plan released by House Republicans in late 2009 already provides the framework for lowering costs. It would allow Americans to buy health insurance across state lines; allow small businesses to pool together to buy insurance; allow private entities greater latitude in following the Safeway cost-cutting model of offering lower premiums for healthier lifestyles; prevent runaway malpractice lawsuits, which lead doctors to practice costly defensive medicine and thereby substantially raise health costs for everyone; and make it easier to use pre-tax Health Savings Accounts (in connection with real insurance, used to cover unforeseen expenses, not routine care)—which let people control their own health care dollars, shop for the best values, and pay for care directly—rather than providing a tax break only for those who funnel their money through insurers. 

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