MENTION health-care reform to almost any assembly of Republicans on Capitol Hill these days, and you will be met with a sigh of exhaustion or indifference. For most returning lawmakers the topic conjures up a QUICK MAKE MONEY ON THE INTERNET near-death experience best not risked again any time soon.
But the issue is not going away. The structural problems with the healthcare system that triggered public anxiety are still there. To be sure, with the economy growing, and with inflation low, fewer today worry about losing their coverage, and health costs are moderating. But that won't last long. Medical prices continue to rise at about double the general inflation rate, so even a modest upturn in inflation will mean a sharp increase in business costs, followed by boardroom bleating for the government to "do something." The next recession will mean another surge in the number of uninsured and--politically more important--more middle-class Americans who fear their families will become uninsured. Furthermore, newly elected Republicans pledged to enact drastic budget cuts and balance the budget will soon have to deal with Medicare and Medicaid spending.
The only way Republicans can dispose of health care as an issue is to tackle it head on and reform it according to conservative principles. Otherwise it will keep coming back, on political ground chosen by liberals. If conservatives allow that to happen, the liberals will prevail. A team that plays only defense eventually loses.
Now is the time to attack. With Republicans in control of Congress, with Democratic health proposals tainted by the Clinton plan, and with Bill Clinton me-tooing virtually every Newt Gingrich proposal, there could not be a better opportunity for a decisive conservative reform of the system.
The crucial task is to change the terms of the debate. Conservatives must end the public perception that only Democrats are serious about addressing this middle-class concern. They need to give a clear idea of what is really wrong with the health-care system and how to fix it. Real welfare reform is possible today only because conservatives changed people's thinking about welfare. Liberals are on the defensive on education because conservatives cogently explained both why the existing public-school system cannot produce educated children and why parental choice is needed to force structural change. In a mirror image of the health-care debate, it is conservatives who choose where, when, and how to fight on school reform. It is liberals who must try to hold off every reform initiative; they know that if they lose one major battle, as they eventually will, they will lose the war.
Conservatives need to wage a similar campaign to wrest control of the health-care debate from liberals and build the case for free-market reforms. We didn't do this in 1994, despite the mauling of the Clinton plan. We neither reinterpreted the problem for the confused middle class nor QUICK MAKE MONEY ON THE INTERNET sought to build public support for a conservative solution. We must do both if we are to end forever the prospect of socialized medicine in America. We must also do both before attempting any sweeping reform of the health-care system. Pushing for radical change without the support of a better-informed public risks a Republican version of the Clinton health-care debacle.
Explaining the Problem
CONSERVATIVES need to explain to middle-class Americans, in simple English, how the poor design of the current system leads to their anxiety. They need to persuade the public that security in health care depends on families choosing, owning, and controlling their own health-care coverage.
It is not difficult to explain this to people, as I and my colleagues at the Heritage Foundation discovered in town-hall meetings held to discuss the Clinton plan. We explained that although a huge tax break--in total worth far more than the mortgage-interest deduction--helps offset the cost of health care, that tax break comes with a big catch. To be eligible for it, each worker has to hand over ownership and control of his family's health plan, including what's covered, to his employer. If the employer uses part of the worker's compensation to provide health-insurance coverage, the employee pays no taxes on the value of that benefit. But if the worker were to pick and purchase his own plan with the same money, he would have to pay taxes in almost every case. The vast majority of working Americans are trapped in an employer-controlled system because of the enormous tax penalty against exercising individual ownership and control.
The typical health-care concerns of today inevitably follow. Changing jobs means changing employer-owned coverage and often doctors too. The new employer may not even provide coverage. Even without a job change, there is the constant worry that the employer will alter the terms of coverage. On the other side of the coin, because the worker does not own and control the plan, or decide how much of his compensation goes to it, he and his family have little or no incentive to economize sensibly on health care.
The loss of family control also means that the health-insurance industry, and hence the whole health-care delivery system, focuses on the needs and wishes of the employer who owns the plan, not those of the worker. In the twenty years I have lived in the U.S., I have never received a telephone call or piece of mail from a health-insurance company seeking my business. Understandably, insurers are interested only in my employer. And their incentive is to cut costs for my employer--for example, by denying claims or subjecting me to impenetrable paperwork before reimbursing me--not to please me. I'm not the customer, after all. I'm merely a "covered employee."
This QUICK MAKE MONEY ON THE INTERNET lack QUICK MAKE MONEY ON THE INTERNET of ownership and control is to the dynamics of health care as Quick make money on the internet the lack of parental choice is to the dynamics of public schools. Conservatives have to explain this to middle-class Americans. It should not be a difficult sell. People who own their homes, automobiles, and life insurance understand why ownership matters.
The solution also is quite salable. Real middle-class security in health care can come only from owning your own health-care coverage. And the only way that will happen is by ending the tax penalties against individual ownership of health plans. Making the tax system neutral in this respect would allow Americans to choose plans directly from insurers or through organizations of their choice, such as churches or unions, as well as through willing employers.
Clear Choices
BY emphasizing ownership and control, conservatives would force liberals into a national debate presenting clear choices. Liberals want a health-care system in which ownership and control of each family's health care is in the hands of employers (as today) or in the hands of government. Conservatives want to put ownership and control--and hence power over insurers, hospitals, and doctors--in the hands of families. Conservatives can win that debate easily, and in so doing we will change the politics of health care, winning public support for a decisive change in federal tax and regulatory policies.
The way to force liberals into this national debate is to copy Clinton's nearly successful campaign to persuade Americans to embrace a socialist health-care system. We should hold our own town-hall meetings around the country to showcase our own victims and advocates. Bring in business people who will explain that employers actually spend their workers' money on health plans. Highlight the farm-bureau and union health plans, as well as the church health systems. Then bring in our experts to point out that an unfair tax system makes it financially impossible for most families to gain the security of choosing such non-employer-based plans. Best of all, introduce Americans to federal workers and members of Congress from their areas who come closest to owning coverage they choose themselves without tax penalty and who don't share the worries of other Americans. In Washington, supplement these presentations with a barrage of official studies and hearings, run by the new Republican majority, to reinforce the grass-roots campaign. In short, do what Clinton and the Democrats did, but use it to sell an analysis and product which, unlike the Clinton plan, Americans instinctively will buy.
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