For decades, federal health policy — through taxes, spending, and regulation — has encouraged people to get their health insurance through their employers, and has encouraged them to choose health plans that pay for routine care. These policy decisions have inflated prices and made insurance harder to obtain for people who don’t have access to employer coverage, and especially for those who have chronic ill health. Obamacare attempted to fix some of these problems, mainly by adding an additional layer of government interventions and attempting to centralize the health-care system.
To remedy this situation, conservatives should do more than reverse Obama’s centralizing moves: They should seek a system in which the federal government does much less to distort health care. More and more Republicans are advocating measures to achieve this goal. Jeb Bush, having just released a strong conservative health-care plan, is the latest to join that list.
Bush would junk the regulatory heart of Obamacare. Gone would be the individual and employer mandates, the federal list of “essential benefits” for which all people must buy coverage, the medical-device tax, and the federally favored health exchanges. Gone, too, we assume, is the extra-constitutional board through which Obamacare intends to centralize medical practices (a separate Medicare plan is on the way from Bush’s campaign and should address this issue).
The federal government would continue to subsidize the purchase of health insurance, as it has done for decades, and as no large group of voters wishes it to stop doing. But it would do so in a much more intelligent way, and with much less effort to manage markets, and it would shift toward this new approach while trying to minimize disruption to most people’s existing health-care arrangements.
#share#Americans without access to employer coverage would receive a tax credit to buy insurance. The amount of the credit would vary based on age, but the credit would not have the complexity and anti-work incentives of Obamacare’s credit, nor would they be tied to its web of regulations. There would be rules to protect people with pre-existing conditions, but they would be designed so as not to rely on forcing everyone to buy insurance. States would be given more flexibility in how they spend Medicaid dollars and related funds: They could, for example, use a lot of that money to let recipients buy insurance on the private market.
Under these reforms, nearly everyone who wanted to purchase an affordable catastrophic health policy would be able to do so — something that cannot be said of Obamacare. The chief benefit of health insurance, protection from serious financial risk, would be very widely available. But Bush also pays attention to the “health” part of health reform, and implements provisions to keep the Food and Drug Administration from being as much of a bottleneck as it has been in the development of new medicines.
#related#We’re not enthusiastic about every element of Bush’s plan. We have less confidence than he does that company wellness programs would produce any benefits worth fighting for. Even some of the positive parts of the plan could be made better: The federal government should probably just cash out a lot of Medicaid, for example, and give it directly to beneficiaries rather than to state governments. While the plan appears to cut both spending and taxes, we would want some assurance that it will not add to the federal debt. None of this, however, changes the fact that these reforms head in the right direction.
Bush’s plan would be much better than Obamacare for the country, for most households, and for limited government. He deserves credit for advancing a well-considered plan to replace Obamacare.