"Repeal Obamacare" is a frequent and popular promise from Republicans running for President and Congress this year but far fewer are talking about what they might put in its place. That's a problem.
ObamaCare was the Left's answer to problems with the American health care system. It's lousy policy to be sure -- from its liberty-strangling mandates to its effect on driving health insurance premiums up and beyond.
But the pre-ObamaCare reality wasn't perfect. Far from it. While many have decried ObamaCare as an attack on the free market, the fact is the American healthcare system even pre-Obamacare was not a free market, as Avik S.A. Roy explains in The Atlantic.
Roy, a Senior Fellow in health care policy at the Manhattan Institute for Policy Research, writes that, while "both liberals and conservatives believe that the American system is a 'free-market' or 'capitalistic' one, and that European systems providing universal coverage are 'socialized'," that conception is wrong.
"If we measure the relative freedom of health-care systems by the dollar amount of government involvement in health spending, the French system is actually meaningfully freer than America's," he writes, though France has what most would call "socialized" healthcare.
"One of the most frequently-made arguments in favor of socialized medicine is that it saves money, relative to the American system. And it is true that Europeans et al. spend less per-capita, and as a percentage of GDP, than we do. But the pro-socialism argument has a glaring weakness: it ignores the two most significant examples of market-oriented universal coverage in the developed world, Switzerland and Singapore, where state health spending is far lower than it is in other industrialized nations. Neither Switzerland nor Singapore could be described as libertarian utopias--both systems contain aspects that conservatives wouldn't like--but they provide powerful examples of how market-oriented health care systems are more cost-efficient than socialized ones."
Roy then explores how the Switzerland and Singapore models work - and how they might be adapted to provide the U.S. a much more free-market oriented alternative to Obamacare:
"The Swiss and Singaporean models wouldn't be perfect models for America; we would want to replace the Swiss individual mandate, for example, with a more market-oriented approach like allowing people to opt out of buying health insurance if they also agree to forego subsidized care. But both Switzerland and Singapore embody the most important principle of all: shifting control of health dollars from governments to individuals.
"How could something like this come about in the United States? One could imagine a scenario in which Medicare was converted into the premium-support model, such as one of the Paul Ryan plans, with far more aggressive means-testing such that upper-income seniors would no longer be eligible for the program. In addition, the tax exclusion for employer-sponsored health insurance is phased out. The resultant savings could be used to offer subsidized private insurance to lower-income individuals, as a replacement for Medicaid. Obamacare's exchanges, though seriously flawed in their implementation, have some similarities to this approach. As these programs converge, we could have something that starts to look a lot like Switzerland. The Singaporean system dovetails with an idea put forth by John Goodman and others of a universal tax credit that Americans could use to buy health insurance, or possibly even Medisave-like HSAs.
"My message to conservatives is: wake up. America's health care system has many qualities, but it is far more socialized than you think, and we can learn from the experience of other countries to make it better. My message to liberals is: if universal coverage is your goal, the possibility for bipartisan compromise exists, if you're open to considering market-oriented approaches like those in Switzerland and Singapore. Let's put our heads together."
Roy is right -- it is vital that conservatives offer more than just a promise to repeal Obamacare.
The reason we have Obamacare is that the Right, once it stopped supporting the individual mandate, has not aggressively put forward a market-based solution to the problems that plagued the American health care system.
Ideas have been thrown out there in the past, but simply throwing them out there isn't enough, especially now that Obamacarehas been put into law. Policy abhors a vacuum. We had a healthcare policy before Obamacare, and we will have one after Obamacare. Conservatives owe it to America to propose free-market policies to replace Obamacare.
Paul Ryan's tax-credit proposal - which he made a few years ago - is a good place to start.