Conservative Case For Obamacare: A Post Debate Perspective

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  • 10/04/2012
If you are part of the small circle of people who lay claim to being a health policy "expert" then you have read and commented on J. D Kleinke's NYT op-ed, The Conservative Case For Obamacare.   JD ( who I have known for at least 20 years) asserts that Obamacare is really based on conservative principles and but for the fact that it covers contraception and that the credit went to the President and not Republicans, conservatives would like the new law.  

Conservative health policy types have written op-eds or posted blogs refuting Kleinke's claim.  Tom Miller, also of AEI,  sums up the response of Kleinke's critics when he writes that Kleinke's op-ed:

"Recycles a fact-challenged rewriting of health-policy history and combines flawed analysis with wishful thinking.
Kleinke argues that the individual mandate and health exchanges of the Affordable Care Act (ACA) were, and should remain, sound conservative ideas meriting Republican support. He imagines that, but for crass political calculations, Republican leaders would be taking credit for what President Obama borrowed from them."

I am not going to pile onto Kleinke.  I woud only add that he wrote nothing new.   The claim that Obamacare is based on conservative proposals and ideas -- and it a carbon copy of 'Romneycare' is a standard Democratic talking point.    Indeed, President Obama stated as much in last night's debate.  

 The New York Times published his piece for three reasons:

1.   He is a resident fellow at AEI, a conservative think tank.  If Jonathan Livingston Gruber had written the article, it would have seen the light of day, which by the way, is a fitting final destination for all of Gruber's work. 
2.   In the article he made the ad hominem assertion that social conservatives want the government to tell women they can't have abortions.  
3.   He endorsed the liberal's view that conservatives made up things like death panels to scare people. 

Without attempting to put words into JD's mouth or op-ed,  I think what he was really trying to say is Obamacare uses the rhetoric of the marketplace, retains in a half-baked way reforms such as HSA and uses tax credits to pay for private coverage, many on the left still dislike the new health law because it's not single payer.   That's the true measure of how market driven Obamacare is and, as a result, conservatives should claim ownership
Indeed, the last line in his NYT piece states: 

"The real problem with the health care plan — for Mr. Romney and the Republicans in general — is that political credit for it goes to Mr. Obama. Now, Mr. Romney is in a terrible fix trying to spin his way out of this paradox and tear down something he knows is right — something for which he ought to be taking great political credit of his own."

Let's grant Kleinke his argument for a moment, that the use of exchanges, tax credits and an individual  mandate to reform healthcare are conservative ideas.   He ignores the most important conservative objections to Obamacare:

1.   It uses price controls to cut spending in Medicare, takes about $60 billion from Social Security and eliminates market choices for seniors to pay for Medicaid for the middle class.   
2.   It uses and creates agencies that will, decide what all health plans should cover,  tell doctors what procedures are "best",  and will 'control'  Medicare spending by deciding what new technologies and treatments to pay for.  

Finally,   conservatives object to Obamacare because it imposes new taxes on most Americans and compells them to buy a product, the price and composition of which is determined by the government.   

The Soviet Union used market mechanisms for it's 5 year plans.   It set prices, decided upon both the array of goods to be produced as well as where they would be sold and at white price.   One year Soviet factories made a lot of shoes for left feet only.   

And all of this would be nearly laughable if people were not compelled to buy the products at the prices set.   But that's in fact what Obamacare is (and Romneycare isn't):  a government created market that only functions because it taxes people and forces them to buy only government developed and subsidized insurance products.  As Grace Marie Turner noted:  "According to a research arm of Congress, the Congressional Research Service, over time, “families will both pay higher penalties and reach the cap at lower income amounts.” This new ObamaCare tax will, like the Alternative Minimum Tax, hit more and more people over time as incomes rise."

I don't know if JD doesn't understand that how a market is organized is more important than calling something a market or if he just using the rhetorical stance to suck up to the NYT.   One thing I do know:  JD has always been an articulate supporter of making consumers more responsible for health care decisions.  In 2003 I sponsored a Manhattan Institute forum where he said: 

"We have come to expect that health insurance should pay not just for disease, but also for impairment, discomfort, and vanity. Why shouldn’t it? Everyone wants something for nothing. It’s human nature. That’s the real problem. The problem isn’t how much better we are getting at finding new medications as a society. The problems is the fact that the health insurance enterprise is gargantuan and ever expanding, along with being inefficient and generating incredibly archaic and bizarre rules.

What’s the solution for this? It’s the simplest thing in the world. Reform the tax code. If people are going to insist on buying everything, down to the $200 deductible with their employer’s money, which is really their money, they should simply continue to do so - but direct that spending personally. It should fall outside of the health insurance premium. Deductibles should be raised to something resembling what we had decades ago, when insurance was involved only when someone got really sick. The premiums for this type of coverage are much lower. And the difference can be set aside, pre-tax, for all that routine spending. This way, for a great deal of the health care entereprise generally, we get consumers far more involved and bureaucrats far less involved."

That's one of the most concise and thoughtful summation of a new health care payment model I ever heard.   JD is not only as smart as the people criticizing him, he has also run and set up health care companies.   That's the JD I know and learned from.    

I disagree with his NYT op-ed and think his characterization of Obamacare as market-driven is either misguided or misleading.  And I believe this attack on the pro-life community was a cheap shot.   

But as Mitt Romney showed in his deft defense of the Massachusetts health reform, there's a grain of truth and insight in what Kleinke wrote.   Tax credits, market competition and increase consumer responsibility are the core of conservative health proposals  have become mainstream, the leading health systems are far and away more efficient and consumer-driven then, say, the VA where delay and sub-substandard care for wounded warriors is the norm.    And as the President demonstrated, liberals see any market-driven changes in our health care system as a threat to a single payer government run system like those in Canada or Great Britain.  Why would the president repeatedly defend a government panel established to decide what new technologies and treatments should be used and whether to pay for them?    Repealing Obamacare means shutting down a government run marketplace and expanding consumer choice.

As JD notes: It's the simplest thing in the world.  


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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