The American people haven't been shy about expressing their views on health-care reform. In the polls and at public events nationwide, they've made it clear that they don't want a behemoth bill that would fundamentally transform a health-care system that works well for most Americans and which offers a level of care that is largely the envy of the world. But they are also understandably concerned about health care's rising costs, its lack of portability, and the ten percent of Americans who are uninsured. They want to see these pressing problems be addressed, but in a sensible and moderate way.
The bill proposed by Senator Max Baucus does not answer Americans' call. The Baucus bill is the real health-care bill, the bill on which the Obama administration is implicitly pinning its hopes. But it defiantly turns a deaf ear to the American people.
Seniors have been quite vocal in their concern that health-care legislation would degrade the quality of Medicare, yet the Baucus bill would gut the popular Medicare Advantage program and would pay for its own huge price-tag primarily through cuts to Medicare and related federal health programs. Seniors won't relish robbing from Medicare to pay for BaucusCare, especially when Medicare is perhaps already the least fiscally solvent program in the United States. But the Baucus bill treats Medicare as if it were a money tree, providing a steady supply of cash to spend elsewhere.
Americans have said that they want more choice and freedom in health care, yet the Baucus bill would mandate that all Americans buy a government-approved insurance plan and would fine them if they don't. Americans are weary of the federal government's profligate spending and intrusiveness, yet the Baucus bill is full of Byzantine regulations that only a lawyer could love, and--according to the Congressional Budget Office--it would cost a mind-boggling $2.9 trillion over 20 years while increasing taxes by $2.0 trillion over that same span.
Furthermore, Americans want insurance to be more affordable. Yet the Baucus bill's requirement that insurers cover all comers--at the same price, at any time--would lead millions to pay the government its fine (still much less than the cost of a premium), quit carrying insurance year-round, and repurchase it only when the immediate need arises. Everyone else's insurance premiums would skyrocket.
The American people don't want any of this. They don't want a huge bill. Instead, they want a small bill that addresses their central concerns without opening the door to far greater problems in the process.
The Democratic leadership's striking failure to listen and to respond to what Americans are saying has opened up a huge opportunity for Republicans to fill the void. Now is the time for Republicans to act--and to unite behind a well-conceived small-bill proposal. As Louisiana Governor Bobby Jindal has argued this week in the Washington Post, Republicans "should seize the mantle of reform and lead."
But Republicans cannot lead merely by stating abstract principles. They must advance specific proposals--ones that are easily understandable and can be expressed in plain language to the American people. The Republican bill should be as short and simple as possible. It should be targeted to address Americans' specific and pressing concerns. And it should make health insurance more accessible, affordable, and portable--without breaking the bank, threatening the quality of care, or jeopardizing the preexisting insurance of millions. It should look something like this.
Something on the order of two-thirds of Americans would likely prefer such an approach to the Baucus bill. Such a small-bill approach would address the problems of the uninsured and of health care's rising costs, while injecting much-needed life into the self-purchased market and enhancing consumer choice. Advancing it would show that the Republicans are listening and responding to the voters. And it would give centrist or fiscally conservative Democrats--who don't really want any part of the Baucus bill but don't want to have nothing to be for--a place to go.
Finally, it would likely prove that the Democrats have been foolish to test the truth of James Madison's words in Federalist 63: "[T]he cool and deliberate sense of the community ought, in all governments, and actually will, in all free governments, ultimately prevail over the views of its rulers." Madison meant either before or after an intervening election.
Many Republican members, including Representative Tom Price and Senator John McCain, have already released or have been developing small-bill proposals along these lines. Perhaps Republicans can coalesce around one of these--remembering to keep it simple--and in the process provide a moderate and politically viable alternative to the Democrats' efforts to impose a government-centric overhaul.
With a sensible small bill in hand, newly empowered Republicans could steer an attractive course between two undesirable extremes: handing the federal government far greater control over Americans' health care, their economy, and their lives--or doing nothing at all.
Download the small-bill proposal here.
Jeffrey H. Anderson, a Ph.D. from Claremont Graduate University, was the senior speechwriter for Secretary Mike Leavitt at the U.S. Department of Health and Human Services.