The Data Agenda

Tuesday, September 10, 2013

Options for replacing the Affordable Care Act

From Forbes:
Comprehensive Republican health reform plans introduced in Congress
Let’s start with 5 comprehensive health reform proposals that have actually been introduced in Congress—some well before President Obama even was nominated for president, and all months before the House (11/7/09) or Senate (12/24/09) voted on what eventually became Obamacare.
Comprehensive conservative Obamacare replacement plans
Likewise, conservative market-oriented health policy scholars have developed a rich menu of potential replacement plans for Obamacare:
The forgotten history of George W. Bush’s comprehensive health reform plan
Too many people conveniently ignore that in his 2007 State of the Union message President Bush proposed a sweeping health reform plan that would have replaced the current tax exclusion for employer-provided coverage with standard tax deductions for all individuals and families. The Bush plan called for a tax deduction that would have applied to payroll taxes as well as income taxes. Moreover, if one were worried about non-filers, the subsidy could easily have instead been structured as a refundable tax credit in which case even those without any income taxes would have gotten an additional amount. This is the kind of policy detail that easily could have been negotiated had the Democrats been in a cooperative mood in 2007. They were not. On the contrary, President Bush’s health plan was declared “dead on arrival” by Democrats in 2007. Yet it is Republicans who were tagged as being uncooperative and intransigent when they resisted the misguided direction that Obamacare seemed to be headed.
What’s sad is that the Bush plan actually was superior to Obamacare when it comes to providing universal coverage. Remember, Obamacare actually doesnot provided universal coverage. The latest figures from CBO says that when it is fully implemented in 2016, Obamacare will cut the number of uninsured by only 45%, covering 89% of the non-elderly. Even if illegal immigrants are excluded, this percentage rises to only 92%. In contrast, the Bush plan (without a mandate!) would have cut the number of uninsured by 65%. But that’s ancient history. Consider one of the newest market-oriented health reform plans put on the table by Jim Capretta and Douglas Holtz-Eakin. Compared to Obamacare, this plan would cost roughly the same amount yet cover 22% more (8 million!) uninsured. If there’s a superior alternative to the slow-motion train wreck now being implemented, why wouldn’t the President and Democrats in Congress want to seriously consider it as a replacement?
Of course even those willing to acknowledge Bush’s health reform plan then tend to counter with the claim that he wasn’t “serious” about his proposal. It was just a defensive move to defend Republicans in 2008 against the charge that the Republicans didn’t have a plan because they didn’t care about the issue (sound familiar). Those dubious about GWB’s “seriousness” about health reform should do the following thought experiment. Imagine that the Democrats in Congress had passed a bill containing the Bush administration’s health plan–no more, no less. Does anyone seriously believe GWB would have vetoed that bill? If not, I would argue his proposal was a serious one.
The twisted history of Romneycare
A favorite debate tactic of progressives is to argue that Obamacare is really a centrist proposal modeled on Republican ideas. Mitt Romney was repeatedlyvilified for his purported hypocrisy in criticizing Obamacare’s individual mandate in light of his having signed Romneycare into law. But an individual mandate for comprehensive coverage is literally a completely different animal than the individual mandate for catastrophic coverage supported by some conservatives going back as far as the late 1980’s. Avik Roy has done a masterful job of tracing this idea’s intellectual roots.  As Mr. Roy has described in great detail, Romney’s visions for health reform was very different than the bill he was actually able to get through a Massachusetts legislature dominated (85%!) by Democrats. Indeed he vetoed  8 different parts of the health reform plan passed by the legislature—including the misguided employer mandate that is now creating so many headaches under Obamacare—but each of these was overridden.  Mr. Roy also has patiently explained how Romney’s successor, Deval Patrick further gutted Romneycare’s market-oriented features.

No comments:

Post a Comment