America’s health-care system was badly in need of reform when President Obama took office. But instead of improving America’s health-care system, the president and his allies have made matters worse. The core problem in American health care is that there is not a functional marketplace in health insurance or health services to discipline costs and promote quality and value for consumers. Rather than empower consumers or encourage the kind of innovation that could make high-quality care cheaper and more accessible, Obamacare has shifted decision-making authority from states, employers, insurers, and consumers to the federal government. This centralization of power in the federal government has already crippled the private initiative that is so essential to delivering improvements in the quality of care for patients. Obamacare’s defenders will insist that for all its flaws, it will nevertheless expand coverage. Yet even after a ten-year gross expenditure of $2 trillion, Obamacare will leave 31 million Americans uninsured in 2021 and beyond.
In this chapter, James Capretta offers a roadmap for conservative health reform. Drawing on new proposals from Republican Senators Richard Burr, Tom Coburn, and Orrin Hatch, and the 2017 project, he calls for an Obamacare replacement that would rely on a decentralized, market-oriented approach to the health-care system; offer tax credits for people outside the employer system achieved with minimal disruption of employer coverage; guarantee continuous coverage protection for all Americans; and grant states significant flexibility to meet the needs of their most vulnerable citizens. The Center for Health and Economy, an independent analytical organization, has found that the Burr-Coburn-Hatch health reform blueprint would expand coverage by as much as Obamacare while spending far less.
Capretta emphasizes that the conservative alternative to Obamacare isn’t just cheaper than Obamacare. Instead of empowering bureaucracies to micromanage the health care system, it empowers a decentralized system of continuous learning and incremental improvement to find solutions, try them out, build on those that work, and reject those found wanting. It is, in this sense, a model of conservative problem-solving.
James C. Capretta is a senior fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute.