Commentary Magazine


Topic: insurance system

An Electorate Receptive to “Repeal and Replace”

Yuval Levin explains that ObamaCare is the worst of all health-care reforms — really no health-care reform at all:

In order to gain 60 votes in the Senate last winter, the Democrats were forced to give up on that public insurer, while leaving the other components of their scheme in place. The result is not even a liberal approach to escalating costs but a ticking time bomb: a scheme that will build up pressure in our private insurance system while offering no escape. Rather than reform a system that everyone agrees is unsustainable, it will subsidize that system and compel participation in it — requiring all Americans to pay ever-growing premiums to insurance companies while doing essentially nothing about the underlying causes of those rising costs.

This is why the ideologically honest Left was just as appalled as conservatives by the result. We are herding unwilling customers into the arms of insurers, passing the bill to the taxpayers, and exacerbating the problem at the nub of the health-care-cost problem — consumers do not foot their own bills and have little incentive to spend wisely and monitor costs. Conservatives have further reason to object to the scheme: “It aims to spend a trillion dollars on subsidies to large insurance companies and the expansion of Medicaid, to micromanage the insurance industry in ways likely only to raise premiums further, to cut Medicare benefits without using the money to shore up the program or reduce the deficit, and to raise taxes on employment, investment, and medical research.” In short, there is enough for everyone to hate.

As Levin points out, there is time to act, given the bill’s implementation schedule. (“No significant entitlement benefits will be made available for four years, but some significant taxes and Medicare cuts — as well as regulatory reforms that may begin to push premium prices up, especially in the individual market — will begin before then.”) Although there are some small benefits scheduled this year to entice voters to embrace ObamaCare (e.g., ban on dropping those already insured for pre-existing conditions, requirements to keep twenty-somethings on their parents’ insurance), these are limited and in some cases duplicate existing state regulations. (Moreover, those who already have insurance — some 80 percent of the population — surely are among the most likely voters.)  Meanwhile, employers are taking a hit and informing their shareholders and employees of the perils of ObamaCare, and the cost problem that was the rationale for the bill worsens:

Rather than reducing costs, Obamacare will increase national health expenditures by more than $200 billion, according to the Obama administration’s own HHS actuary. Premiums in the individual market will increase by more than 10 percent very quickly, and middle-class families in the new exchanges (where large numbers of Americans who now receive coverage through their employers will find themselves dumped) will be forced to choose from a very limited menu of government-approved plans, the cheapest of which, CBO estimates, will cost more than $12,000.

Throw in a plethora of new taxes and perverse incentives for employers to drop their employees from coverage, and you can see why it is an “unmitigated disaster — for our health care system, for our fiscal future, and for any notion of limited government.” But there is time to rip it up and start again. There is no shortage of market-based alternative plans from conservatives. But first, the existing one must be abandoned before it can do permanent damage to the health-care system and to our economy. That is the rallying cry for conservatives this year and in 2012 — to prevent the wrecking ball before it hits its target and to offer a better alternative. Rarely is there such a stark choice for voters, but there is no fuzzying up the differences between the two sides on this one. Are you for or against a giant new entitlement program? Do you think individuals should be forced to buy insurance plans they don’t want? Is it smart to levy huge new taxes when the economic recovery is stalled? If framed clearly, the “Repeal and Replace” brigade has a compelling position.

The unfolding debate also comes within a certain context, one the Obama administration chooses to ignore. The public has not, contrary to the Left’s expectations, become enamored of big government in the wake of the financial meltdown. To the contrary, the bailouts and stimulus plan have engendered suspicion and contempt. The “Trust us, it’s working!” rhetoric has contributed to the public’s growing unease with governing elites. And the mound of debt has reinforced the public’s suspicion that the White House and Congress are unserious and ill-equipped to address our fiscal train wreck. In other words, the “Repeal and Replace” contingent will be making its case to an electorate already predisposed to accept much of its argument.

Yuval Levin explains that ObamaCare is the worst of all health-care reforms — really no health-care reform at all:

In order to gain 60 votes in the Senate last winter, the Democrats were forced to give up on that public insurer, while leaving the other components of their scheme in place. The result is not even a liberal approach to escalating costs but a ticking time bomb: a scheme that will build up pressure in our private insurance system while offering no escape. Rather than reform a system that everyone agrees is unsustainable, it will subsidize that system and compel participation in it — requiring all Americans to pay ever-growing premiums to insurance companies while doing essentially nothing about the underlying causes of those rising costs.

This is why the ideologically honest Left was just as appalled as conservatives by the result. We are herding unwilling customers into the arms of insurers, passing the bill to the taxpayers, and exacerbating the problem at the nub of the health-care-cost problem — consumers do not foot their own bills and have little incentive to spend wisely and monitor costs. Conservatives have further reason to object to the scheme: “It aims to spend a trillion dollars on subsidies to large insurance companies and the expansion of Medicaid, to micromanage the insurance industry in ways likely only to raise premiums further, to cut Medicare benefits without using the money to shore up the program or reduce the deficit, and to raise taxes on employment, investment, and medical research.” In short, there is enough for everyone to hate.

As Levin points out, there is time to act, given the bill’s implementation schedule. (“No significant entitlement benefits will be made available for four years, but some significant taxes and Medicare cuts — as well as regulatory reforms that may begin to push premium prices up, especially in the individual market — will begin before then.”) Although there are some small benefits scheduled this year to entice voters to embrace ObamaCare (e.g., ban on dropping those already insured for pre-existing conditions, requirements to keep twenty-somethings on their parents’ insurance), these are limited and in some cases duplicate existing state regulations. (Moreover, those who already have insurance — some 80 percent of the population — surely are among the most likely voters.)  Meanwhile, employers are taking a hit and informing their shareholders and employees of the perils of ObamaCare, and the cost problem that was the rationale for the bill worsens:

Rather than reducing costs, Obamacare will increase national health expenditures by more than $200 billion, according to the Obama administration’s own HHS actuary. Premiums in the individual market will increase by more than 10 percent very quickly, and middle-class families in the new exchanges (where large numbers of Americans who now receive coverage through their employers will find themselves dumped) will be forced to choose from a very limited menu of government-approved plans, the cheapest of which, CBO estimates, will cost more than $12,000.

Throw in a plethora of new taxes and perverse incentives for employers to drop their employees from coverage, and you can see why it is an “unmitigated disaster — for our health care system, for our fiscal future, and for any notion of limited government.” But there is time to rip it up and start again. There is no shortage of market-based alternative plans from conservatives. But first, the existing one must be abandoned before it can do permanent damage to the health-care system and to our economy. That is the rallying cry for conservatives this year and in 2012 — to prevent the wrecking ball before it hits its target and to offer a better alternative. Rarely is there such a stark choice for voters, but there is no fuzzying up the differences between the two sides on this one. Are you for or against a giant new entitlement program? Do you think individuals should be forced to buy insurance plans they don’t want? Is it smart to levy huge new taxes when the economic recovery is stalled? If framed clearly, the “Repeal and Replace” brigade has a compelling position.

The unfolding debate also comes within a certain context, one the Obama administration chooses to ignore. The public has not, contrary to the Left’s expectations, become enamored of big government in the wake of the financial meltdown. To the contrary, the bailouts and stimulus plan have engendered suspicion and contempt. The “Trust us, it’s working!” rhetoric has contributed to the public’s growing unease with governing elites. And the mound of debt has reinforced the public’s suspicion that the White House and Congress are unserious and ill-equipped to address our fiscal train wreck. In other words, the “Repeal and Replace” contingent will be making its case to an electorate already predisposed to accept much of its argument.

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