Jindal--"ObamaCare Repeal Needs a Direction" He is Exactly Right

quote:

---

ObamaCare Repeal Needs a Direction
Focus on reducing the costs of health care, and more Americans will end up getting covered.

---

quote:

---

Before you start a journey, it helps to know where you are going. That’s obvious advice—but instructive as Republicans consider next steps in the effort to repeal ObamaCare. Before getting lost in arcane Senate rules, technical modifications to the existing law, or Congressional Budget Office scores, conservatives must define for themselves and the American people what they are actually trying to accomplish.

Watching the recent debate, one could be forgiven for thinking that simply getting a deal done was the goal. The now-withdrawn American Health Care Act of 2017 was seemingly written by House leaders with the sole purpose of winning over the most recalcitrant Republican senator. The real goal must be something larger, more inspiring and more important than merely getting to a signing ceremony.

Republicans have historically offered creative proposals for tax reform, foreign policy and defense spending. The GOP’s health-care ideas, however, too often have been developed in opposition to Democratic proposals. Republicans want to spend less than Democrats do, but that approach only slows government expansion; it doesn’t change government’s direction. The GOP has now tried and failed to replace ObamaCare with its own, less expensive entitlement program. Rather than simply tweaking the previous failure, why not take a completely different approach?


Although I disagreed with the late Sen. Ted Kennedy on policy, I respected him for always keeping his ultimate goal in mind and consistently working toward it. He took small steps toward the single-payer system he wanted when Republicans were in the majority, and larger steps when his party ruled. He helped create the State Children’s Health Insurance Program when Newt Gingrich was House speaker, and inspired the Affordable Care Act when Nancy Pelosi had the gavel.

Republicans must be similarly single-minded about taking control of the health-care system from bureaucrats and returning power to patients and doctors. In the current debate, Republicans must choose between two related goals—lowering costs and increasing coverage. Which will we prioritize?

Putting coverage expansion first, as President Obama did, leads to insurance plans with narrower provider networks, higher deductibles and stingier benefits. Consider the disabled Medicaid beneficiaries on waiting lists for community-based services, or the families on exchange plans who cannot see their children’s specialists. The cheapest way to ensure everyone has coverage is to ignore the adequacy of that coverage.

When Republicans debate which ObamaCare regulations to keep, they should remember they are dictating that the private market offer products whose pricing and benefits do not make financial sense. Many insurance companies are abandoning markets in which it is not sustainable for them to operate.

The next logical step—and Vermont Sen. Bernie Sanders is already there—is for government to cut out the middleman and simply offer the coverage itself. The populist argument for expanding Medicare (or Medicaid) to all Americans is hard to resist, at least when coverage is the primary goal. But when everyone gets health insurance from the government, doctors will lose their autonomy and patients their choice. America’s health-care system will innovate less, and quality and efficiency will deteriorate—as they always do in a top-down, command-and-control system.

Under a single-payer system, special interests—such as large hospitals and medical technology providers—would use the political process to obtain favorable pricing and coverage decisions while keeping out competitors, and political elites would exempt themselves from the burdens they impose on the rest of us. Politicians would be loath to disrupt entrenched interests, harming instead the dynamism of the market and millions of individual decisions that speed up the development of life-saving cures. But, some will say, at least everyone is covered.

It does not have to be this way. The alternative is to focus on lowering costs, not merely covering them up through subsidies or wealth transfers. Instead of simply offering cheaper versions of Democratic proposals, Republicans should offer principled health-care reform that is bottom-up, not top-down.

A successful ObamaCare replacement should harness the power of choice and competition. Republicans should allow insurance companies to compete across state lines and allow patients to select the benefits and cost-sharing they want. The GOP should expand the use of health savings accounts, crack down on frivolous lawsuits, and encourage competition among providers by expanding the scope of what they are legally allowed to do and removing barriers to entry.

Republicans should rewrite the tax code to encourage health-care saving (not just spending), make health coverage portable, and create incentives for wellness programs. They should establish voluntary purchasing pools with legal and tax benefits while giving states much more flexibility over their Medicaid programs and grants to increase access for those with pre-existing conditions. They should put pricing and quality information online, speed up the FDA approval process, and crack down on industry abuses to increase generic drug competition.

The main problem with American health care before ObamaCare was cost. ObamaCare has made matters worse—both on the individual level, with dramatic premium increases, and the corporate level, by driving the country further into debt.

At first glance, the choice I am urging Congress to make between increasing coverage and lowering costs seems like a choice between motherhood and apple pie. Can’t health-care reform do both, just as the beer commercials once promised great taste and lower calories? Yes—but as we have seen, prioritizing coverage expansion results in higher costs and lower quality. Focusing on lowering costs is the way to increase coverage in a meaningful and sustainable way.

Mr. Jindal, a Republican, served as governor of Louisiana, 2008-16.

---