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Republicans, Give Me Something to Work With
I’ve been having some breakthrough conversations about politics and government with a Millenial who works with me. He’s an intelligent lad, and well-informed, though his limited life experience hasn’t chipped away at his idealism yet.
He has a number of conservative views and opinions — net neutrality, big data, TSA, etc. — although he doesn’t necessarily recognize them as such. But hey, it’s a start.
However, when it comes to healthcare he’s “all in” on ObamaCare, mostly because of pre-existing conditions and coverage until age 26.
Here’s my frustration: he’s willing to listen, and I’ve shared many of the faults of ObamaCare as well as ways that health reform could be done more effectively and less intrusively. What’s lacking, however, is having a tangible, accepted Republican approach to demonstrate what a good healthcare program looks like.
Sure, Paul Ryan, Bobby Jindal, Tom Price, and a few others have put forth some ideas, but they seem to have come and gone. Without a philosophy, a plan, and some concrete actions, it’s just my hypotheticals against his experiences with ObamaCare, which haven’t been negative to-date.
Republicans, please tell me what you stand for on healthcare and what you want to accomplish so I can pass it along to my Millenial friend.
He’s listening… for now.
Image Credit: Shutterstock.
Published in General
Licensing. Regulation. Yup, that pretty much does it.
It doesn’t sound like your friend knows the definition of insurance.
My soapbox peeve: let’s call it medical care and medical insurance.
It’s not your neighbors’ job (or your employer’s) to make sure you are in good health. And when you are healthy you don’t need medical care.
As an analogy: how expensive would car insurance be if it covered oil changes, the 30 and 60K services, replacement of the timing belt, clutch, etc?
(Disclaimer: I work in an ancillary care profession and at least 80% of my income is from Medicare.)
Just a few thoughts.
Finally, what MLH said: As an analogy: how expensive would car insurance be if it covered oil changes, the 30 and 60K services, replacement of the timing belt, clutch, etc?
The difference with health care insurance is that our society isn’t willing to tell those without insurance or adequate insurance, you are SOL if you need emergency care. Hence the costs get passed on through higher medical prices and taxes to support the poor or those who choose to spend the dollars elsewhere.
On the one hand, I think Republicans were fools (or corrupt and sneaky) to accept Democrats’ premise that Obamacare is at least better than the situation before Obamacare. They trapped themselves into an expectation of replacing one big government program with another one (or they wanted a big government program and like to pretend otherwise).
On the other hand, now that the expectation exists and that Obamacare has distorted the market beyond the extent to which it was already screwed up by government interference, Republicans must indeed offer a clear alternative… even if it consists entirely of repealing previous arrangements or revising Medicare.
“Trust me” isn’t going to cut it these days.
Aaron,
Excellent. Thanks.
I just browsed around the web and found this website with a great looking proposal for health care reform. Is this the kind of detail you’re looking for? The big problem is that conservative health care proposals don’t make for easy soundbites. Obamacare as promoted by its supporters, did, although those soundbites were clearly false (starting with “affordable” and moving on from there).
If your insurer took an HMO approach to it, these services would probably be a lot cheaper.
If this Millennial is smart, he or she is going to ask for examples rather than an exposition of theory about why a (for eg) free market approach should logically deliver better standard outcomes (medical and financial).
There have been times that the US had a Republican President – and States had Republican legislatures and Governors – what did they come up with that was better (in what specific ways) than Obamacare and how?
I’m young yet, but I’m not aware of any major initiative under either Bush that freed the market of government’s tentacles. Republicans have offered tax breaks and subsidies over the years to buy Grandma’s vote. But they haven’t freed insurance companies of burdensome regulations or enacted tort reform at the national level.
Texas capped lawsuit payouts against medical practioners years ago, so there is at least a track record of some Republican effort at the state level. I don’t know what other states have been up to.
Since Republicans at the national level are worthless, I could only ask a searching voter the question that challenges all entitlements: Were all of your ancestors jerks?
Because if the answer is “no”, then the only possible conclusion is that there are other ways to care for the sick, poor, and elderly than by government programs. Yes, people did actually care about each other before the New Deal and government largesse. For modern examples, see all the spontaneous fundraisers for this and that personal struggle since the rise of the internet. Before people immediately looked to Uncle Sam for help, people used to look to their neighbors.
Unless it was mandatory, in which case it would be more expensive and less reliable.
Do you want to convince him to be a Republican, or do you want to convince him to be a conservative?
Because if you point to GOP efforts re: health care reform, you’ll find little on offer. As your friend has probably in turn pointed out, there haven’t been any GOP bills other than Obamacare repeal. If, however, you point to the work that Yuval Levin or Jim Capretta have done, you’ll show him a somewhat coherent and conservative approach.
The example I used with my students which got through to them was to imagine everyone had food insurance that was good for whatever you wanted to purchase from any food store or restaurant.
As a result of 3rd party paying, everyone pays 10 times more for food than they do now and salaries are much lower than they would otherwise be.
The solution is very high deductibles and health savings accounts to pay the deductibles. The vast majority of people will never get near the deductible limit, and so the price of everyone’s insurance will be very low.
The 2nd big point: There is no reason for medical insurance to come from employers. That it does causes all kinds of dislocations, not the least of which is people who don’t change jobs or start businesses because they are afraid to lose their insurance. If insurance were purchased by everyone on the individual market that problem goes away.
Insuring for pre-existing conditions is not insurance at all, but is a welfare payment, much like allowing someone to purchase insurance for a house after it’s burned down. A better approach is to set up a system where everyone who buys insurance when young and healthy can keep it forever and the price stays the same as others in his age cohort regardless of his medical condition. If he rolls the dice and waits till he’s older to purchase insurance, he will pay much more, as we currently do with life insurance.
A culture in which no one waits till he’s old and sick to get coverage obviates 95% of the “pre-existing” problem. The other 5%, the people who are sickly from their early years, can be handled by dedicated welfare programs, not the insurance system.
Twenty-six year old “children” who claim they are old enough to vote, drink, have children and abort them, etc., are old enough to afford their own medical insurance, especially if it is as cheap as it would be under the program I’m describing. Besides, the 26 year rule only applies to “children” of parents who have insurance from their employers. Others are currently left to their own devices.
The primary effect of ObamaCare has been to move the terror of no medical coverage onto people who work and used to have it.
Bravo, Mw/Axe. Bravo!
This is exactly it. I’ve been saying: we should insure our bodies the way we insure our cars. Major medical insurance would not be overly expensive I don’t think, and you could compete for it, and understand it. Because you generally understand your auto-insurance, and it would work in almost exactly the same way. For the sniffles and the twisted ankle, you’d pay for it yourself. Because everyone would be doing this, there would be more competition, and you’d be in a position to dicker with the doctor, and the price would be lower than what it is now. All a person needs to do is look at an EOB and see that nobody is paying full price anyway.
Of course, this requires people to be responsible with their money, set a budget, plan. Your friend is likely to say “But people won’t do that!” To which you say “So what? I believe in freedom. And sometimes freedom means letting people suffer the consequences of their own mistakes.”
Of course, this means removing all of the layers and layers of crap that has built up over the medical care system.
(I’m going to take advantage of unlimited comment size while I can…!)
Both Bush and McCain had proposals to overhaul our healthcare financing system, and the plans were substantially similar. The principles behind them also undergird most of the current Republican proposals.
The essence goes back to the disparate tax treatment for health insurance. An individual pays for health insurance with after-tax dollars, whereas a corporation pays for health insurance with pre-tax dollars. (There is a history behind this, going back to WWII wage controls. No need to elaborate on that here.) The upshot is that it is more cost-effective for an employer to pay for its employees’ health insurance than to pay the employee in cash and have the employee shop around. So most Americans get their health insurance through their employers. This has brought a number of downsides for employees — a lack of portability, difficulty getting health insurance when unemployed, and difficulty with preexisting conditions — and there have been legislative attempts to mitigate them. As a further result of this, the market for employee health insurance is robust, but (since the pool of individual buyers is much smaller) the market for individual health insurance is not.
The GOP proposals have mostly sought to decouple health financing from employment, with minimal disruption to current arrangements. As a rule, they level the field between employer-sponsored and individual coverage by changing the employer tax deduction to an individual tax credit. Here’s a (highly simplified) example. Say that today an employer pays $10,000 in premiums for employee Joe, and would have to pay $15,000 cash for Joe to afford the same benefit after paying taxes. The general approach of the GOP proposals is to make the premiums taxable like other compensation, but then give the employee $5000 off of his taxes for having health insurance, regardless of whether the insurance came from the employer or he bought it himself. That way, Joe would net a $10,000 benefit either way. The employee would be indifferent to getting insured by an employer vs. getting cash and shopping around. The hope — reasonable to assume, but not certain — is that a more robust individual market would then develop.
There are other provisions in each proposal (with slight differences among them) to deal with preexisting conditions. There are also differences on the size of the tax credit. But the main Democratic attack on the GOP proposals has been that they “raise taxes” by making the employer benefits taxable — demagoguery that ignores the offsetting tax credit, which would now be universally available!
The most significant split among GOP proposals right now is how to reach such an end state. Yuval Levin proposes (in a recent NR issue) a gradual rollback of Obamacare. Avik Roy proposes repealing it from the inside out, effectively turning the Obamacare exchanges into a free market for all individual shoppers. IMO, this split is the main sticking point that is preventing Republicans from coalescing behind a single proposal.
I always say “I’m all for single payer, so long as the person doing the paying is the person getting the medical care.”
Yes. McCain even ran on his proposal.
Unfortunately, Bush 43 only introduced his plan after the Congress elected in the 2006 GOP wipeout was seated.
Critical to this, of course, is the ability for the employee to really shop around, and not be limited to plans that meet his state’s regulatory issues. If there is a plan in Idaho that meets my needs, I can buy it, even though I live in Washington.
I think one of the problems conservatives face is that we’re realists. And no realistic system can ever compete with the utopian fantasies offered by the Left.
I am certain that there are many things we could do to improve the health-care system in this country. But a free-market solution, while probably optimal, can never promise universal affordable coverage for every condition. It just isn’t possible, any more than it would be possible to give everybody a free Lexus every year. Unfortunately, we’re up against ideological opponents who are perfectly willing to make unrealistic promises, and most voters are eager to believe them.
I think that’s why most conservatives tend to focus on arguments that ObamaCare won’t work, rather than proposals for an alternative. Because honestly, I’m skeptical that any *realistic* alternative would ever sound attractive enough to be persuasive.
If the Millennial is smart, he or she is going to be able to compare the % of GDP spent on healthcare (the US 18%, Australia 10%, just for example, for very similar health care technology, universal coverage and better financial outcomes) and draw some conclusions.
The point is – I understand the theory that the free market should make things cheaper and more efficient – and largely that is 100% true, because if you don’t pay for something you don’t get it. The reason health care is different (demonstrably, see % GDP etc. above) is that people are not really willing to let the improvident die in a ditch, and this basic and almost unchangeable fact about advanced human societies skews the market.
This seems to be the challenge to the GOP, and more specifically conservatives, overall. We articulate what we are against, and are only too happy to have the mainstream media (that we rightly berate) help us get that message out. They frame our positions as ” Against, no, do not want, need to stop, need to eliminate, and finally, take away” (my personal favorite).
And that is what independents and those that might rally to our cause hear. What they don’t hear is what we are for. Our solutions.
And that is because we’re not focused on offering any. Could we make a list of solutions to real world problems our neighbors perceive as critical that we as a party, or a movement, offer? You could probably pick a handful of officeholders that are focused on solutions (Paul Ryan being the most obvious).
Here in California, we’re stuck with Neal Kashkari as our standard bearer, because we have no bench – there is no one on our side championing ideas, and specific solutions, so there is no support. We’ve allowed the left to buy votes with our tax dollars and our bond debt. Now that has become the culture of California – ‘what can you give me’?
Personality matters (Gov. Christie). Policy matters (Gov. Jindal). But until we start offering solutions, and marry them to consistent messaging, we’ll continue to pick through the left’s table scraps.
This is true, except for the “unchangeable” part.
If you pay for the improvident, you will get a surplus of improvident people. We must stop paying for them, and create a culture where no one will see being improvident as a feasible strategy. Today, it is the best strategy, especially under Obamacare’s pre-existing condition rules.
Well you may lose your Millennial there.
And are there really more improvident people in universal coverage Massachussets than Texas? (Leave alone Canada or Australia? Really?)
Which is why any Republican plan must make the division between insurance and welfare clear. And the tax code must be simplified so that political interests are not hidden in the form of tax breaks and subsidies. Transparency is the greatest threat to Big Government.
Republicans present their plans as if they are in a boardroom meeting. Any voter intelligent, informed, and interested enough to care about the details can easily find and study those details in online walkthroughs if Republicans make those detailed guides available for reading. TV appearances have more sway with low-information, non-ideological voters, so the messages communicated through mainstream media should be inspirational anecdotes of private charities and neighbors helping neighbors.
Republicans talk to voters as they would talk to themselves. That’s bad PR. That’s bad salesmanship. If you want to sell an idea, you have to communicate as the particular audience wants or needs to hear it. If Republicans knew how to sell their ideas, then we could more realistically estimate how open the majority of voters are to such ideas.
The US Federal gov’t was/is supposed to only do 3 things. Providing medical care wasn’t/isn’t one of them. And don’t go saying “providing for the common good” does mean so. There still really is something to the American character.
O.K., back to Millennial thinking. I’ve had some success in arguing that accepting government money as the airy-sounding “subsidies” then gives the benefactor more legitimacy to intrude in your personal decisions. Ask any young adult if they’ve heard the “as long as you live under my roof and I pay for your food, you’ll follow my rules” mantra and they start to get it. If this system relies on a quasi-parental investment from the federal government, does it not then have the authority to attach limitations/restrictions/requirements on your behavior and decisions?
And, if the system is devised that the vast majority can only afford the insurance on offer with those subsidies, does that not then portend a vast intrusion in to personal liberty?
This usually starts them on the road to the larger questions. Are government decisions benign? Neutral? Prone to partisanship? What are the dividing lines between personal and public responsibility?