very member of Congress should be required to pass a test to demonstrate that they have read every word of "Bitter Pill," Steve Brill's astonishing 28-page TIME cover story, which uses the experiences of ordinary Americans to detail just how big a cluster you-know-what America's health-care system is. If you have not read it, it makes for heavy and highly emotional reading. You will be at times offended, at times confused, and at times just downright angry at the details that emerge. Most of all, the article is important because it explores, in considerable detail, the true source of our nation's fiscal problems: Health-care spending.
Conservatives in particular need to take notice of the problems that this article explores. Really, the GOP should treat each quandary like a math problem that needs solving. Put another way, the GOP must stop carping about ObamaCare and instead address all of the problems that the president's preposterously expensive piece of legislation did not sufficiently address. Intentionally or not, Brill tells a story that highlights the central problems that tomorrow's Republican Party must solve if it wants to reduce America's deficit and return our country to prosperity.
Of course, for years Republicans have acted on the assumption that America has the "best health-care system in the world," probably because most of their constituents seem satisfied enough with their coverage. Old people like Medicare, and polls indicate that those people who can afford health insurance like their policies. But as Avik Roy of the Manhattan Institute and many others have noted, American wages are stagnant because the cost of health care has skyrocketed. In 1999, the average individual health insurance plan cost 11 percent of per-capita income. In 2010, it was 19 percent.
Put another way, whether you realize it or not, health care is getting more expensive without getting all that much better. And that surge in the cost of care is one of the central causes of America's fiscal crisis. Conservatives, of all people, should be offended by this trend. After all, it is driving the dire state of our fiscal health.
For all of ObamaCare's flaws (and there are many), Avik Roy has suggested that if Republican policymakers really gave a damn about policy (as opposed to just rhetoric), they would shut up about "repealing" the statute and refocus their energy on harnessing existing provisions to create more desirable policy outcomes. (Roy also makes a convincing case that conservatives should aspire to make our health-care system look more like Switzerland's…. Seriously, his arguments are very, very good.)
Republicans should be at war with the fee-for-service model of financing health-care reform. Presently, doctors are principally reimbursed for the services they perform rather than the outcomes they bring about. That means that under the prevailing model of medical reimbursement, a doctor who performs 20 tests on a patient will make more money than he would if he performed two — even if he achieved a superior or equally positive patient outcome by performing fewer tests and spending less money. Republicans who care about the deficit and believe in paying for superb care must find creative ways to rid the health-care system of the cancer that is fee-for-service billing.
Similarly, the GOP should focus on obliterating the regulations that liberal groups like the AMA have created and helped maintain (such as restrictions for retail health clinics) because they wish to protect their members from having to compete to provide even the most routine forms of health care.
Most of all, though, the GOP must understand that the deficit is first and foremost a product of health-care spending. If conservatives are serious about restoring the party's credibility, then we ought to be worrying about how to bring costs under control without compromising the quality of care. There are many problems calling for conservative solutions… if only the GOP would have the political courage to push for change.
Jeb Golinkin is a 3L at the University of Texas School of Law and writes about U.S. politics and policy for TheWeek.com. From 2008 to 2011, he served as an editor and reporter for Frum Forum/New Majority. Follow him on Twitter (@JGolinkin) and email him at email@example.com.
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