Republicans should blow up the entire health-care system
Pretty much everyone hates the House GOP's new health-care plan. And they're right to. As my colleague Michael Brendan Dougherty explains, the plan is unworkable: It doesn't get at the deepest problem with American health care, namely that it is an absurd ballet between third-party cartels.
Republicans have been talking for decades about health reform that would put choice back in patients' hands, and thereby unleash the forces of competition that would deliver innovation and relentless cost decreases, as they have in every other non-government-run high-tech sector, like automobiles, computers, and phones.
Pop quiz: What's the only high-tech sector that sees rampant price increases with mediocre increases in quality, besides health care? Fighter jets. And what does that industry have in common with health care? That's right, the government.
The way American health care works is insane. Imagine if car insurance worked like health insurance, and didn't just cover low-probability, high-cost events (you know, the textbook definition of "insurance") but also recurring, low-cost events like getting gas and changing your oil, and you had to go through your insurance to fill up your tank. I guarantee that you would have miles-long lines for gas, you could only fill up at stations that are part of your insurance company's network because of some byzantine business deal, a tank of gas would be billed at $2,000, and half the time instead of gas you would get sesame oil in your tank.
That system would be absolutely insane. No one in their right mind would live with it — that is, unless the government made it the law that that's how car insurance worked.
Now imagine that the system had worked this way for so many decades that nobody could even conceptualize a world without it. Imagine a parallel universe where this has been the way forever, and you find yourself trying to explain normal car insurance to people in that parallel universe. Car insurance that only covers wrecks? But I could never afford $2,000 a week for a tank of gas!
After a while, the denizens of this absurd land would almost certainly trot out sophisticated "car economists" (because that would totally be an academic specialty) who would pull out charts to explain why your idea is nice and fine in theory but cars are such a special sector of the economy that they could never work the way you want. At this point, you might break down and cry.
Welcome to how conservatives see the health-care debate in the U.S.
This is why ObamaCare was so frustrating. Progressives looked at America's insane system, and instead of doing anything to truly change it, said, hey, let's just spend some government money buying insurance for more people. This is why RyanCare is equally frustrating, because it also does nothing to truly fix the system. It just spends less money doing it, which, without altering the underlying system, really is cruel because, within the system, those who don't have insurance really are up a creek without a paddle.
As Dougherty points out, the reason why the insane system is so resilient is, in part, because people just can't imagine the common-sense alternatives anymore, but also because the upper-middle class, America's most powerful constituency, benefits from the status quo. Because they have the best insurance in the country, they object to any truly meaningful change in the system; even though they also would benefit in the long run, status quo bias means they won't give an inch.
But in that dreadful status quo, there lies an opportunity. As Dougherty points out, the GOP's health reform is doomed to be radioactive no matter what. So if you're going to push something radioactive, you might as well make it good.
If there was one virtue you might have expected out of the election of Donald Trump as president, it is that for better or worse, he has expanded the field of what was previously thought politically possible. Trump is non-ideological. He doesn't care what health care looks like, he just cares that it be "winning."
So if Republicans are going to go for broke anyway, if they're going to piss off everyone (mission accomplished!), they should at least piss them off with a truly conservative and radical health-care solution.
Republicans should make a law mandating that every American enrolled in an employer-sponsored health-care plan receive the premiums their employer pays into a personal health savings account. Those Americans would be automatically auto-enrolled back into their employer-sponsored plan; for those who don't want anything to change, nothing would change; but for those who want to shop for a better option, they'd be able to. This would be the most radical thing you could do for health care. Everyone else also gets a health savings account, and those who are poor get it filled up by the government with a sliding scale.
And what about catastrophic expenses? Well, this is the radicality and potential political viability of the plan. If you have to spend more than 20 percent of your yearly income on health care, the government picks up the bill. That's right: Medicare-for-all! As a conservative I don't like it, but even I have to admit that it can't be that much worse than the status quo, especially if I get all the other things I like.
Something like this has been proposed by a number of pragmatic progressives, like the economist Brad De Long and the business executive David Goldhill, but also conservative heroes like Milton Friedman. Do non-catastrophic health care through health savings accounts to introduce consumer dynamics in the health-care system and get rid of the worst aspects of the status quo. And for catastrophic expenses, have the government cover everyone. Politically, instead of some awful centrist compromise, it would combine the best idea of the radical right (total decentralization) and the best idea of the radical left (government as final backstop). That's the best kind of bipartisanship, i.e. the kind that never happens in Washington.
Is it crazy? Probably. Is it political suicide? Probably. But the GOP's current approach is definitely crazy and definitely politically suicidal.