Michael Swartz / November 9, 2018

Health Care as a Selling Point

Unless Republicans can figure out a unified policy, they’re going to struggle in years to come.

Eight years ago last week, conservative voters and their allies in the Republican Party stormed the ballot box and made a statement about the policies of Barack Obama: They didn’t want anything to do with them. While Obama’s Keynesian-on-steroids stimulus program was the original impetus for what became the Tea Party wave, by the time the 2010 midterms rolled around, voters were demanding the repeal of the newly passed and ridiculously named Affordable Care Act — already dubbed as ObamaCare — and Republicans won by promising to deliver.

Three days ago, that hard-won majority in the House melted away, in part because Republicans who vowed to rid Americans of the scourge of ObamaCare couldn’t deliver the goods, even when they had the trifecta of controlling both houses of Congress and the White House. (The House voted numerous times over the years to repeal ObamaCare while safe in the knowledge that any actual repeal would die in the Senate or be vetoed by Obama.)

Granted, the way the architects of ObamaCare rolled out the program was very shrewd: They began by instituting popular features like removing lifetime coverage limits, allowing children to remain on their parents’ policy until the age of 26, and — most important — eliminated the prospect of paying through the nose for insurance due to a pre-existing condition.

That latter aspect was by far the most popular, so much so that people stopped clamoring for repeal even as rates and deductibles surged. Eventually, Republicans gravitated from the promise for a straight repeal to “repeal and replace.” Thus, as the GOP ceded the argument for eliminating the Affordable Care Act, ObamaCare became the new foundation in the structure of American health care.

Now, after nearly a decade, most working Americans under 30 are more interested in repealing ObamaCare only if it’s replaced by “Medicare for All,” because they don’t remember any other system. We found out Tuesday just how effective that re-education was. As the ranks of GOP representatives and candidates, particularly from suburban areas, were decimated by Democrats, it became clear that the Left’s promise of a different kind of health care reform had won the day. As The Washington Post reminded us pre-election, health care was Americans’ top issue, and those who thought so preferred the Democrats by a whopping 58%-34% margin.

Unfortunately for congressional Republicans, their somewhat incoherent messaging regarding health care never reached the mainstream. While Democrats derided newly available short-term insurance policies and association plans as “junk insurance,” they represented more of what insurance was intended to be — a shared hedge against risk as opposed to blanket coverage for every possible malady under the sun. Moreover, a recent Wall Street Journal editorial put the lie to the Democrats’ contention:

Speaking of association plans, the returns are coming in on the Democratic claim that allowing employers to band together to offer coverage is “junk insurance.” The plans are still nascent, but look at what the Las Vegas Metro Chamber of Commerce is offering: nine plan choices; dental, vision and life coverage available; pre-existing conditions covered; and more, with premium rates locked in for two years.

This is no surprise. The selling point of association plans is that businesses can pool risk and cut overhead costs. Businesses want to offer generous coverage that helps to attract workers in a tight labor market.

Add in new rules allowing employers to offer workers tax-exempt dollars to buy insurance in the individual market, and it appeared that, rightly or wrongly, the Trump administration was doing its own end run around Congress — just as Barack Obama often did when Republicans ran the House.

But it wasn’t in Obama’s interest to encourage free-market solutions, and under a new Democrat-controlled Congress, this sort of reform could be once again an endangered species. Generation Z writer Alex Muresianu noted in the Washington Examiner that, while the Trump idea of bringing transparency to pricing was a good idea, an even better one would be universal catastrophic care — a sort of “ObamaCare lite,” in which the government covers major medical events and allows the rest to be covered through HSAs or supplemental insurance.

Even President Trump, that champion of deregulation, isn’t immune from letting his populist side show up. Days before the election, he brought forth a proposal to regulate drug prices, in part by comparing our rates to an “international pricing index.” Ironically, it came shortly after the president’s Council of Economic Advisers came out with a report on the opportunity costs of socialism, where they concluded, in part:

With health insurance, to name one of the major industries in the U.S. economy, socialists promise great results if only the state is granted a monopoly and its goods and services are distributed free of charge. Such a state enterprise would be far larger and more centralized than any the Nordic countries have ever seen. …

The historical evidence suggests that the socialist program for the U.S. would make shortages, or otherwise degrade quality, of whatever product or service is put under a public monopoly. The pace of innovation would slow, and living standards generally would be lower.

We never seem to learn that lesson, perhaps because we rely on political solutions instead of the state-level and market-based solutions we know are out there. Had the Republicans taken advantage of the opportunity to keep their ObamaCare promise — and, more important, had a transition program ready to go — Tuesday’s House races would have likely been a reward for a roaring economy instead of a GOP bloodbath.

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