As gridlock persists in our nation’s capital and good legislation continues to die in the Senate, it is clear the next president will play a key role in determining the future of Obamacare. That means candidates’ positions on the issue will be among the most important when ballots are cast next year.
Obamacare’s “three-legged stool” — the subsidies, guaranteed-issue rules and individual mandate — is already collapsing under its own weight. The failing Obamacare co-ops mean that more than 500,000 Americans have lost their health plans, while individuals face a new wave of premium increases — about $600 a year on average for a silver-level federal exchange plan. The individual mandate is overreaching and ineffective; Obamacare’s attempt to stop “pricing out people with preexisting conditions,” as a Nov. 2 Post editorial put it, has priced out people who don’t have preexisting conditions; and while the subsidies primarily benefit those below 200 percent of the poverty level, the majority of Americans are worse off.
If Hillary Clinton or Bernie Sanders wins the White House, the only question will be how much she or he can expand Obamacare, growing our debt and raising taxes in the process.
I know there is a better path. That is why I recently proposed the most substantive conservative plan to repeal and replace Obamacare presented to date. My Obamacare alternative addresses the root causes of high health-care costs, offers patients more options and strengthens the safety net for the most vulnerable Americans.
First, my plan would lower costs. Health care is expensive primarily because Washington has long distorted the meaning of “insurance.” Health insurers pay the majority of bills and control how most health-care services are delivered.
Under my plan, instead of an insurer directly paying all the bills, consumers would be empowered to make choices that are right for them. For instance, an asthma patient could save money by choosing a treatment costing $8,000 instead of one from a different hospital in the same city costing $34,000.
Additionally, medical entrepreneurs would be given better opportunities to develop new approaches to delivering care. Instead of getting paid every time a diabetic patient came into the office, what if a specialist could manage all of that patient’s diabetic care, including the use of remote monitoring technology, for a one-time payment? Such an approach might save money and lead to better outcomes.
But this does not mean patients would be on their own to cover costs; rather, they could choose from a range of innovative coverage options. Patients may spend far less on premiums and be able to save more for out-of-pocket costs with a health savings account (HSA), and they may select a high-deductible plan that offers them a defined amount when they need certain services, so that they can select a specialized physician to provide them. And states could supplement the value of plans for the poor by fully funding HSAs.
The point is that individuals, instead of insurers, would control more of the health-care dollar, via tools such as HSAs. My approach would also make these HSAs work better for those with chronic conditions by offering plans with lower deductibles for certain services related to a given condition and would establish transparent information on the value of services so consumers have the information they need to make informed choices and demand value.
Second, my plan promotes innovation. It can take 12 to 15 years and more than $2 billion to develop a new cure for a disease. In a $3.1 trillion system, efficiency and effectiveness are desperately needed; yet under the current system, health-care start-ups face costly and complex government overregulation. My plan would overhaul Washington’s entire approach to innovation, including modernizing the Food and Drug Administration, investing in the National Institutes of Health and promoting big-data solutions in health care. Advances can be led by the creativity of America’s scientists, care providers and innovators.
Finally, my plan would strengthen the safety net. The primary goal of the tax credits for the purchase of insurance included in my plan is to finally achieve tax fairness between the employer and individual health insurance markets. A middle-class family that needs to purchase health coverage should get a tax break similar to what another middle-class family receives through an employer. The tax credit would benefit low-income Americans, and my plan would enable the states to target additional resources to the needy by supplementing the value of the credit.
Furthermore, these changes would complement reforms to Medicaid that replace unnecessary rules with an approach that insists on results. The most exciting improvements we have seen to the safety net have come from the states breaking free from Washington’s rules, and we need to build on those successes. With the right tools and accountability in place, states can achieve far better outcomes for the poor.
Unfortunately, Obamacare was built on top of a 1940s- and 1960s-era system. A 21st-century health-care system requires innovation and an overhaul of this antiquated structure. Only then will all Americans realize the lower costs, better options and greater possibilities of the future.
Jeb Bush was governor of Florida from 1999 to 2007 and is a Republican candidate for president.