2) We should quit defending employment-based health care. The leading Republican spokesman in the House on these issues, Rep.Paul Ryan, repeatedly complained during floor debate that the Obama plan would "dump" people out of employer-provided care into the exchanges. He said that as if it were a bad thing.
Yet free-market economists from Milton Friedman onward have identified employer-provided care as the original sin of American health care. Employers choose different policies for employees than those employees would choose for themselves. The cost is concealed.
Wages are depressed without employees understanding why. The day when every employee in America gets his or her insurancethrough an exchange will be a good day for market economics. It's true that the exchanges are subsidized. So is employer-provided care, to the tune of almost $200 billion a year.
3) We should call for reducing regulation of the policies sold inside the health care exchanges. The Democrats' plans require every policy sold within the exchanges to meet certain strict conditions.
American workers will lose the option of buying more basic but cheaper plans. It will be as if the only cable packages available were those that include all the premium channels. No bargains in that case. Republicans should press for more scope for insurers to cut prices if they think they can offer an attractive product that way.
I might disagree with some of his statements (like on taxes earlier in the article), but at least they're realistic ideas worth considering. Obamacare would be better if we did the two things he mentioned. It would also be better if we followed the Republican governors' suggestions to implement national exchanges. Bravo.
And while I prefer a different mechanism for financing and providing health care (as a single-payer system has proven, time and again to be far more efficient that a private system), I appreciate the sentiment from at least one Republican who says that at least we do need to do something about the uninsured. Even though I consider the employer mandate to be a crappy mechanism, it's much better to have it as a part of insuring 30 million Americans. The benefits of the ends, in this situation, far outweigh the costs of the means.
But help me with a messaging issue, please. How can anyone convince Americans that ending employer mandated insurance is a good thing, when literally every right-wing media outlet is kicking up a shit-storm about how "you'll lose your health insurance."
If employer-based coverage is such a bad thing, why would the right make such a huge deal of forcing democrats to make sure it stays? This was the key attack that derailed Hillarycare, Democrats' attempt to fix this problem back in the 90s. And it's why Obama, time and again, has to go back to this silly idea of "you can keep your [employer-provided] health insurance," even though that's probably false for a lot of people.
Look, employer-based health insurance is going the way of the dinosaurs, mandate or no mandate. Avik Roy estimates that the Fortune 100 will save more than 400 billion dollars by dropping coverage and paying the "fine." Many others will follow suit. The CBO already estimated that in the first 5 years after Obamacare is implemented, employers covering 5 to 20 million people will drop their coverage.
Why not? The incentives are already there, and they'd be even stronger without the employer mandate. This shouldn't bother anyone. Remember, as David Frum said, it's a good thing for employers to be getting out of the insurance business. Let government provide the safety net, and let employers focus on business. It's a far more normal arrangement anyway.
The "fine" will just turn into another way of paying for this, a hidden tax that we'll get through because the Grover-Norquist types would go apoplectic otherwise. And the irony of all this is that it's probably the best deal that these employers could get. If anyone takes the time to look at the bill, this alternative will cost them far less than actually providing health insurance, and it was far less than most other ideas for maintaining the current system. The current mandate will allow for a gradual transition to a better, more rational health insurance system. Win-win.
But this issue about repeal and the blind opposition to the bill needs to be dropped right away. The ACA is part of sweeping reforms of entire, broken medical system (6 out of 7 doctors say it needs fixing). We can't get there until one side drops all of this repeal nonsense and starts looking for actual solutions. While the ACA is doing some work towards improving outcomes, cost is one area that the right has plenty of room to contribute on. The ABIM Foundation gets the ball rolling. Is anyone else gutsy enough to pick it up?
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