Karl Rove makes the argument that “public option” healthcare reform would be irreversible and send us on our way “to becoming a European-style welfare state.” He then proceeds to list the key arguments against such a move. It is unnecessary; it will destroy private insurance coverage; it will force us onto a government plan; it is too expensive. And:
[T]he public option puts government firmly in the middle of the relationship between patients and their doctors. If you think insurance companies are bad, imagine what happens when government is the insurance carrier, with little or no competition and no concern you’ll change to another company.
He’s right, but it is not clear how it can be stopped. After all, the Democrats have a lot of votes. And lots of unworkable, expensive, and unwise legislation is getting through these days. It seems that those opposed to the plan have their work cut out for them. But perhaps it’s not such an uphill battle. The three immediate tasks for those opposing a government takeover of healthcare: impress upon lawmakers that the risk of doing nothing is lower than the risk of passing a horrible bill, dissolve the phony coalition in favor of a vague concept of “reform,” and present a viable alternative.
First, it is important to remember that the public isn’t clamoring for what the president and Democratic leaders are pushing. When you look carefully, it is apparent that there is not much of a mandate for universal healthcare coverage. Yes, the vast majority of people want “healthcare reform.” But in a new poll:
Forty-nine percent of voters want to focus on controlling the cost of health care while 35 percent say the priority should be expanding coverage for Americans without health insurance. One of the proposals on ways to pay for a health care overhaul that gets a big thumbs-down is taxing health benefits. That’s opposed by 68 percent of voters while 26 percent support it.
So the first task is to convince lawmakers that there is not much upside to passing something the public doesn’t really want and a huge downside to wrecking a system most voters like just fine. The real risk to their re-election prospects is passing a bunch of taxes to pay for a huge government-run plan.
The next task is to pierce the canard that “everyone” is in favor of this. After a few dog-and-pony shows at the White House it is easy to come away with the impression that everyone is on board. But frankly, there is substantial opposition to what the president and Congress are cooking up. Most noteworthy, the A.M.A. has come out against a public option:
The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.
Is Obama going to get between patients and their doctors? It seems so.
And finally, it is hard to beat something with nothing. But there are plenty of alternatives that get to the heart of the matter — the rising cost of healthcare and the disconnect between purchasers and payers of healthcare insurance. James Capretta has outlined what it might look like: a transition from employer-provided to individually purchased insurance, with no public option but enhanced competition. In May, he and Yuval Levin described what that would entail:
The core of such a reform would involve replacing the tax exemption for employer-based health coverage with a new federal tax credit for everyone. This would convert millions of passive insurance enrollees into cost-conscious consumers shopping in an insurance marketplace. But unlike past iterations of this approach, conservatives should propose to pursue it in stages, beginning with small businesses and the uninsured–groups with poor existing options and thus not averse to change.
Will it “work”? One doesn’t know but counting on the president’s plan to collapse because it is foolhardy, financially disastrous, offensive to free market principles, and bureaucratically unmanageable is a bad bet. The key is getting lawmakers on both sides of the aisle to see it is in their self-interest to find something better.