Published in American Maggie, September 9, 2009
The overwhelming backlash against the Washington-centric health reform proposals making their way through Congress has clearly put the Obama administration and its allies in Congress on the defensive, altering the health reform debate.
The American people want their voices to be heard: They are frightened by a cascade of big spending programs that move power and control away from individuals and toward centralized bureaucracies.
Senate Majority Leader Harry Reid and House Speaker Pelosi shamefully cast as “un-patriotic,” “angry mobs,” and “evil-mongers” average Americans who came to town hall meetings around the country this summer asking thoughtful questions about health reform and how the proposed massive restructuring of one-sixth of our economy would affect them.
With trillions of taxpayer dollars being spent – and billions being wasted – by a government that is accumulating unprecedented amounts of debt, people do not trust politicians to get a 1000-plus page health reform bill right, and they are determined not to let Washington experiment with their personal access to health care.
The American people do not want a $1 trillion-plan that includes a new government-run health program, burdensome mandates on employers and individuals to purchase health insurance defined in Washington, and a big expansion of the Medicaid program that is bankrupting the states Instead, President Obama and Democratic leaders could gain bipartisan support by moving forward with a targeted approach that would improve access to quality, affordable care.
First, we need to help the uninsured with a refundable tax credit. This credit would improve access to health insurance for the uninsured by giving them help in purchasing health insurance, just as workers receive who have employment-based coverage.
They could use the refundable tax credit to take advantage of health insurance that might be offered at work, buy coverage on their own, or through new groups that would emerge in a market where health insurance and subsidies are portable. Millions of uninsured Americans would benefit without hurting the vast majority of people who are satisfied with their current health insurance and want to keep it.
People would have the security of coverage that they can own and keep their insurance with them over time. They wouldn’t have to change from one doctor or one network to another when their employer changes health plans or when they change jobs. This would lead to better continuity of coverage and care.
Second, Congress should allow insurers to offer health plans across state lines. This would lead to greater competition among insurers and provide Americans with more choices in health coverage – also a key goal of reform efforts. Opening the health insurance market to nationwide competition would give people more choices of policies that aren’t burdened by expensive state regulations which drive out competition and drive up prices.
For instance, those in high-cost insurance states like New York and New Jersey would now have a choice in purchasing more affordable plans offered in lower-cost states such as Pennsylvania. People could choose the best plan for them and their families and, by their choices, would put pressure on companies to become more efficient and flexible.
Third, we need to provide a stronger safety net for people who have trouble buying coverage because of pre-existing conditions or chronic health problems. But such a program would be best managed by the states which are closer to the people and their needs than by one clumsy and unresponsive federal bureaucracy. Providing grants to the states to lower health costs and increase access would be a much more effective and efficient route to reform.
The private sector also should be given new incentives to refocus our health delivery system by paying for better medical outcomes, not just for performing procedures and tests. That’s how we should start our efforts to reform Medicare and Medicaid. Improving transparency is crucial to this effort so people can know how well doctors and hospitals are performing. Arming the public with important performance information such as infection rates, frequency of procedures, and cost of procedures promises to improve health care quality and allow individuals to make wiser health care decisions – another key goal of reform efforts.
Any reform efforts must encourage innovation and the continuous process of improving health care quality. Americans will benefit from medical innovation if new drugs to fight diabetes, cancer, and Alzheimer’s can be brought to the market, and if employers are encouraged to offer innovative solutions to health care, including wellness incentives in health insurance arrangements.
These targeted changes do not require huge new government bureaucracies and would be embraced by a public skeptical of a radical health care overhaul. Most importantly, they would improve access to more affordable, higher quality health care – a goal we all share.
Grace-Marie Turner is president of the Galen Institute, a non-profit research organization based in Alexandria, VA, that specializes in free-market ideas for health reform.