A STRONG SOCIETY
Promote Patient-Centered Health Care
Perhaps no issue reflects the need for market-based reform more than health care. A health care system focused on opportunity would empower each patient and his or her doctor and improve health care quality, access, and affordability. Instead, we have a system that centralizes more and more decision-making in Washington.
Health policy generally aims to improve health care quality, access, and affordability. Of these three, in America, cost is the central problem. Health care quality in the United States is second to none. To the extent that access remains a problem for some, solving the cost problem offers the best hope of addressing their needs.
The left and the right have competing approaches to health reform. The left’s vision is to put government in the driver’s seat of health care decisions through command and control. The pre-Obamacare system, the left posits, exemplified all of the worst excesses of capitalism: a messy competition for margins in which individual insurers’ uncoordinated efforts could generate healthy profits only through deception and gouging of consumers. Obamacare is built on the assumption that profit-seeking corporations can deliver affordable care to all Americans, but only if private motivations are subordinated to common interest through heavy regulation.
In effect, the government has turned insurance companies into public utilities, promising them a comfortable existence in exchange for eliminating competition. They cannot set their own prices; they cannot choose the services they provide; they cannot select their customers; they cannot create innovative business models or products that might “game” the system and undermine competitors.
The law provides massive incentives to insurers for cooperation. It offers them a steady stream of customers through its requirement that all Americans purchase their products. It provides bailouts for companies that cannot bear the costs imposed by its regulations. Most important, its regulatory hurdles eliminate the potential for disruptive business models that could threaten the standing of the strongest players in the market. Insurance executives, the left hopes, can be trusted to give consumers a fair deal and reduce costs—so long as they are guaranteed comfortable annual returns and insulated from threats in the marketplace.
A better alternative for health care reform would give individuals choice and control of their health care dollars and decisions. This vision stems from an alternative view of the state of the pre-Obamacare system. Properly understood, there was no patient-centered market for individuals. Rather, our health care system has long been among the most segmented and least market-driven sectors of our economy. A large portion of the country receives government-controlled health care from Medicare and Medicaid. Meanwhile, market mechanisms have long been impeded in the private sector by the tax code’s arbitrary preference for employer-provided care, which serves to prevent consumers from choosing the plans best suited to their needs.
The result of all these distortions is unsurprising: an individual market that has long lacked an adequate consumer base on which to thrive. In such circumstances, it’s no wonder that the industry could not provide the market signals that exist in most other sectors of the economy and serve to drive prices to affordable levels.
Obamacare’s solution to the health care problem is to regulate “bad” plans in the individual and group markets out of existence and drive individuals toward government-approved and taxpayer-subsidized health plans. A conservative solution to health care would do the opposite: It would give individuals and families the freedom to choose the plan that best suits their needs from a marketplace in which insurers and providers have the flexibility to compete to provide better care at lower cost.
To get there, Congress should guarantee fair tax treatment that allows each individual to buy insurance with tax benefits that are similar to the tax benefits available for those with employer-based coverage. Individuals who like their company-provided insurance should not be forced out by government overreach like Obamacare, but by the same token, Americans should not feel locked into employer-provided insurance due to unfair tax treatment of individually purchased plans.
Furthermore, there is no reason why Americans in government-run health care—Medicaid and Medicare recipients—should be locked out of the benefits of choice and competition. Reform of these programs would introduce the same kinds of market mechanisms that can better address patient needs while driving down costs for consumers and taxpayers alike.