Republicans should blow up the entire health-care system
If Republicans are going to piss everyone off, they might as well propose a radical plan
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.
Subscribe to The Week
Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.
Sign up for The Week's Free Newsletters
From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.
From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.
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.
Create an account with the same email registered to your subscription to unlock access.
Sign up for Today's Best Articles in your inbox
A free daily email with the biggest news stories of the day – and the best features from TheWeek.com
Pascal-Emmanuel Gobry is a writer and fellow at the Ethics and Public Policy Center. His writing has appeared at Forbes, The Atlantic, First Things, Commentary Magazine, The Daily Beast, The Federalist, Quartz, and other places. He lives in Paris with his beloved wife and daughter.
-
Bormio: 'a great Alpine getaway'
The Week Recommends From snowy slopes and hot-spring spas, to high-end food and wine, this Italian town has something to offer everyone
By Asya Likhtman Published
-
Crossword: March 28, 2024
The Week's daily crossword
By The Week Staff Published
-
Sudoku medium: March 28, 2024
The Week's daily medium sudoku puzzle
By The Week Staff Published
-
Trump, billions richer, is selling Bibles
Speed Read The former president is hawking a $60 "God Bless the USA Bible"
By Peter Weber, The Week US Published
-
The debate about Biden's age and mental fitness
In Depth Some critics argue Biden is too old to run again. Does the argument have merit?
By Grayson Quay Published
-
How would a second Trump presidency affect Britain?
Today's Big Question Re-election of Republican frontrunner could threaten UK security, warns former head of secret service
By Harriet Marsden, The Week UK Published
-
'Rwanda plan is less a deterrent and more a bluff'
Instant Opinion Opinion, comment and editorials of the day
By The Week UK Published
-
Henry Kissinger dies aged 100: a complicated legacy?
Talking Point Top US diplomat and Nobel Peace Prize winner remembered as both foreign policy genius and war criminal
By Harriet Marsden, The Week UK Last updated
-
Trump’s rhetoric: a shift to 'straight-up Nazi talk'
Why everyone's talking about Would-be president's sinister language is backed by an incendiary policy agenda, say commentators
By The Week UK Published
-
More covfefe: is the world ready for a second Donald Trump presidency?
Today's Big Question Republican's re-election would be a 'nightmare' scenario for Europe, Ukraine and the West
By Sorcha Bradley, The Week UK Published
-
Xi-Biden meeting: what's in it for both leaders?
Today's Big Question Two superpowers seek to stabilise relations amid global turmoil but core issues of security, trade and Taiwan remain
By Harriet Marsden, The Week UK Published