By Bobby Jindal
Wednesday, August 22, 2018
Democrats point to the supposedly existential threat of
climate change and the nation’s allegedly inhumane immigration system as
reasons to give them control of Congress this November. Yet their failure to
prioritize these issues and pass legislation when they controlled the White
House, the Senate, and the House during Obama’s first two years in office belie
their seriousness. Republicans are currently demonstrating a similar hypocrisy
by failing to act on their supposed political priorities, including repealing
Obamacare and reducing federal spending and borrowing. Even more dangerously,
Republican failure to advance significant conservative solutions to the
problems voters care about is setting the stage for Democratic overreach.
Merely enacting temporary tax cuts and repealing some of
Obama’s regulations will slow down, but not reverse, the expanding role of
government. Reagan was the last Republican president to disrupt the march of
progressivism; the Gingrich Congress’s welfare reform was the last significant
victory. A majority of voters still prefer effective conservative market-based
solutions to their real-world problems, but they will settle for government
subsidies and dictates as a second-best solution if Republicans fail to offer
an alternative. Republicans’ failure to address rising health-care costs when
they were last in the majority led directly to Obamacare, and their failure to
act today will result in a single-payer system. It all seems fine now, but
remember this moment if and when we get single-payer.
Moderate Republican policymakers err by simply enacting
cheaper versions of Democrat proposals, expanding the welfare state, but less
generously. The voters targeted by such proposals rightfully reject weaker
liberals, preferring the real thing, and these Republicans refuse to learn the
hard lesson that they will never outspend Democrats or sate their appetite for
government largesse. Their libertarian counterparts argue against any role for
government, preferring to preserve their purity to addressing voter
frustration, e.g., with rising health-care costs. There is an incremental third
option that supports policies that strengthen market-based solutions.
This is not to excuse the failure to repeal Obamacare, or
to substitute for continued attempts, but there are stand-alone conservative
reforms that Republicans should enact to begin addressing voter concerns about
rising health-care costs and strengthen a consumer-driven system.
Just as there have been previous bipartisan efforts to
make health-care data more secure and portable for patients, consumers would
also benefit from more price and quality transparency. Patients have more
information when buying a car than when selecting a health-care provider.
Government should not be dictating prices to the market, but it can play an
important role in promoting competition. This simple reform could save
consumers tens of billions of dollars annually.
Liberals of course often take a good idea and go too far:
Obama justified drastic restrictions on health-plan flexibility in the name of
easing comparison shopping. Forcing health plans to act like regulated
utilities, with severely curtailed ability to innovate on prices or features,
is not the solution. It is one thing when Ford tells customers they can have
any color Model T, as long as it is black; it is another when government is
making that decision.
Other incremental reforms that will reduce costs without
harming quality include:
• Cracking down
on frivolous lawsuits and excessive damages.
• Allowing
providers to practice to the full scope of their training.
• Removing
certificate of need and other restrictions on new competitors.
• Supporting
state high-risk pools and other reinsurance mechanisms to assist those with
preexisting
conditions.
• Allowing
consumers to purchase insurance across state lines.
• Giving
individuals purchasing their own health care, the intended beneficiaries of
Obamacare,
access to the same
benefits of group purchasing and tax-advantaged spending enjoyed by those
who
get their health
insurance through their employers.
Trump’s varying responses to rising drug prices are a
testament to the clash between the populist potency of the issue and
traditional Republican defense of the industry. Democratic proposals to have
government set prices will surely deter innovation and future investment, but
Republicans cannot simply protect the status quo. The Food and Drug
Administration has sped up approval of generic-drug applications, increasing
price competition, and Commissioner Scott Gottlieb has prioritized cases where
no cheaper alternative currently exists. There are bipartisan reforms that
would go further — for example, forcing brand companies to provide samples to
generics, denying patent extensions for meaningless changes, and cracking down
on payments from brand companies to generics to prevent competition. Innovator
companies deserve the patent exclusivity they earn for bringing new cures to
market, but these abuses make a mockery of the free-market system and, if not
corrected, invite more drastic interventions.
Republicans are right to continue pushing for giving
states more control over their Medicaid programs, in the form of grants and a
federal focus on outcomes rather than process, but there are smaller steps they
can take in the meantime. Seema Verma, administrator of the Centers for
Medicare and Medicaid Services, is allowing states to impose work requirements
and more rigorous eligibility verifications on the able-bodied, copying the
successful welfare reforms of the 1990s, which will encourage self-sufficiency
and return Medicaid to being temporary assistance for many. Republicans can go
further by giving states more flexibility over benefit design and cost-sharing
and encouraging premium-assistance programs, which help beneficiaries purchase
private coverage rather than enrolling them in a one-size-fits-all
government-run program.
Republicans have an opportunity and obligation to lead.
That is the consequence of winning elections. The best way to have prevented
Obamacare in the first place was to render it unnecessary by showing the
superiority of market-based solutions. Now is the time for Republicans to
address voter concerns, preempt a single-payer system, and pressure red-state
Democrats to vote for commonsense reforms.
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