Fix Health Reform, Then Repeal It

Rep. Paul Ryan in the NYT:

ON Thursday night, Congress sent to President Obama the reconciliation package to remove some of the embarrassing provisions in his signature legislative achievement, health care reform. But a serious fix for what ails health care in America will entail far more than merely tweaking the new law of the land; we will need to repeal the entire faulty architecture of the government behemoth and replace it with real reform.

To be clear: it is not sufficient for those of us in the opposition to await a reversal of political fortune months or years from now before we advance action on health care reform. Costs will continue their ascent as the debt burden squeezes life out of our economy. We are unapologetic advocates for the repeal of this costly misstep. But Republicans must also make the case for a reform agenda to take its place, and get to work on that effort now.

So what can we do?

Health care experts across the political spectrum acknowledge that a fundamental driver of health inflation is the regressive tax preference for employer-based health insurance. This discriminatory tax treatment lavishes the greatest benefit on the most expensive plans while providing no support for the unemployed, the self-employed or those who don’t get coverage from their employer.

Reform-minded leaders like Senator Ron Wyden, Democrat of Oregon, and Senator Tom Coburn, Republican of Oklahoma, pushed legislative proposals that would directly address this issue. I helped write a plan that would replace the bias in the tax code with universal tax credits so that all Americans have the resources to purchase portable, affordable coverage that best suits their needs, with additional support provided for those with lower incomes. All these ideas, though, were dismissed early on, as they didn’t fit with the government-driven plan favored by the majority. But going forward it’s important that we reconsider this regressive tax issue.

Then, when helping Americans with pre-existing conditions obtain coverage, we should focus on innovative state-based solutions, including robust high-risk pools, reinsurance markets and risk-adjustment mechanisms. I intend to continue advancing true patient-centered reforms like attaching tax benefits to the individual rather than the job, breaking down barriers to interstate competition, and promoting transparency and consumer-friendly coverage options.

We should ensure that health care decisions are made by patients and their doctors, not by bureaucrats, whether at an insurance company or a government agency. By inviting market forces into health care, we can encourage a system where doctors, insurers and hospitals compete against one another for the business of informed consumers.

We must also immediately begin dealing with our crushing debt burdens, which this legislation will worsen. The Democrats’ fiscal arguments never did add up: they claim that their program will reduce the deficit even though the federal government will pick up the tab for more than 30 million uninsured Americans and subsidize millions more. Even after accounting for the $569 billion in tax increases and $523 billion in Medicare cuts, the true costs of this legislation — concealed by timing gimmicks, hidden spending and double-counting — will make the deficit explode, plunging us deeper into debt.

Washington already has no idea on how to pay for its current entitlement programs, as we find ourselves $76 trillion in the hole. Our country cannot afford to avoid a serious conversation on entitlement reform. By taking action now, we can make certain that our entitlement programs are kept whole for those in and near retirement, while devising sustainable health and retirement security for future generations.

The case for attempting health care reform was not difficult to make. Skyrocketing health care costs are driving more and more families and businesses to the brink of bankruptcy, leaving affordable coverage out of reach for millions of Americans and accelerating our path to fiscal ruin. The challenge was how to deal with the seemingly inexorable increase in health care costs.

Yet the Congressional majority went at this goal backward: with the force of the federal government, cover all Americans — then figure out which screws to twist to contain costs. Democrats opted for this approach because their concern was never about costs. It was about expanding coverage through an expansion of government.

As the dust settles from this historic and fiscally calamitous week, we have to try to steer this country back in the right direction. The opposition must always speak with vigor and candor on the need for wholesale repeal and for real reform to fix what’s broken in health care.