Economics, Entitlements, Health Care

Better health care for America

A road map from the court’s ruling to real reform
Supreme Court of the United States of America

Regardless of the Supreme Court’s decision on the Patient Protection and Affordable Care Act, majorities of Americans want Congress to make changes to the health care law.

AEI is charting the way. The guide below outlines questions presented to the high court and provides a route for policymakers to map a new future.

Follow the court’s decision path and click on the question marks to discover innovative, free market-based recommendations to expanding coverage, ensuring benefits, and reducing the growth of government in health care.

Hover over the top-left of the graphic to see a larger version.

Watch AEI scholar Jim Capretta outline six principles to guide health care reform.

3 thoughts on “Better health care for America

  1. It is regrettable that PPACA has been called Obamacare, both because its flawed thinking did not originate with Obama. Rather than a rational discussion about how to fix healthcare the dialogue becomes one about people’s feelings about the President. Let’s not go there! Similarly, getting healthcare right is not about big government versus small government, high taxes or low taxes. Even if healthcare were 100% tax funded rather than employer funded we would still need a vigorous, competitive private sector to actually render the care efficiently and responsively. Conflating the two issues unnecessarily alienates millions of potential supporters of market-oriented healthcare reform.

    That said, all of the ideas put forth by Bob Moffitt and Jim Capretta make great sense. However they don’t deal with several realities that must be faced for real reform to succeed:

    1) Any reform will have winners and losers, and some of the potential losers are very powerful politically. Moreover since Citizens United people and organizations with a lot to lose from a policy change can use their money without limit to punish legislators who stand their ground and insist on rational policy.

    2) Not all people are rational actors; in fact, some are irrational because their health problems affect their insight, judgment, and sometimes even their ability to calculate. A system that depends on consumers’ judgment must provide a safety net for consumers whose judgment is impaired. This can be addressed with special provisions for people with bona fide neurological or psychiatric conditions related to their failure to maintain coverage.

    3) Similarly, in economic hard times unemployed people might rationally put food, shelter, and gasoline for their cars ahead of maintaining their health coverage, particularly if they are healthy at the time. Such people might not be poor enough to be entitled to Medicaid. This problem should be addressed in the design of premium supports for low income people.

    4) An affordable reinsurance plan that would pick up coverage for the care of catastrophic illnesses – federally subsidized if necessary – would enable insurance plans to have per-patient maximum benefits without imposing unacceptable risk on consumers. This would enable more innovative startups in the health insurance industry, and greater willingness of smaller plans to develop solutions for chronically ill, high utilizing patients.

    5) Advocates for true market-oriented healthcare reform should dissociate their agenda from extraneous issues like abortion and contraception. There are many socially liberal individuals who would support market-oriented healthcare reform if it were presented cleanly.

    6) The VA health system proves that a true government-owned (not merely government-controlled) healthcare system can be efficient and innovative – and in the case of the VA a dedicated government-run system is logical because it serves a national population with common military experience and very specific issues like combat related trauma that are expensive and out of scope for most private plans. Continuing to support the VA – and perhaps even other rational and well-defined public services for defined populations (e.g. the chronically mentally ill) – can be rational and is compatible with a market-oriented viewpoint. Set private enterprise free, but keep some public options when there are important constituencies that need them and when the public approach delivers good value.

    7) Strong public support for medical research, including comparative effectiveness research, makes sense, too, especially if the findings are utilized selectively and critically by private healthcare systems. All of us benefit from good research but few private entities are large enough to support their own internal research programs.

    Dealing with considerations like these can open the minds of people who are not already conservative partisans. This is essential to building the kind of broad national consensus we need to reform healthcare and stand firm against special interests that fight reform. Obama made a mistake to force through the PPACA with not a vote to spare. Conservatives should not make the same mistake and force through a replacement that 49% of the public doesn’t want.

  2. Barry,
    The Disaster-in-Chief is rather proud of the PPACA being referred to as ObamaCare and has even used that moniker himself.

  3. Free market competition is the only way, you will have winners and losers, just like with government run healthcare, the only difference is the number of losers you have. With government healthcare the loser rate goes up, with private free market system the number of losers goes down, dramatically. And every honest objective adult in america knows this.

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