No one can accuse Rep. Paul Ryan of merely carrying coals to Newcastle. He takes his argument for the repeal of ObamaCare to the pages of the New York Times today, attempting to school its readers on the actual issues of pricing opacity and tax-policy warping of the markets. More importantly, Ryan pledges action, not obstruction:
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. …
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.
Of course, this is nothing new to those of us who have listened to Paul Ryan over the last year. Ryan has repeatedly promoted these very ideas, both on the stump and in actual legislation. That may be news to NYT readers, however, given the sparse coverage of Ryan’s proposals until Barack Obama made a big tactical error in holding his health-care summit in February — which forced the media to cover Ryan’s specific criticisms and proposals.
While I think Ryan’s reforms would work to undo the damage of ObamaCare and the tax policies of the last several decades, they could go a bit farther. The best outcome would be to get rid of the idea of comprehensive insurance altogether and move towards catastrophic insurance instead. That would alleviate the existing-conditions issue, since insurers wouldn’t be paying for routine medical services, and would encourage more providers to enter a more competitive market. Innovation would follow, and everyone would get healthier as a result.
However, that’s just a quibble at this point. The real need is to repeal and replace, for which Ryan makes an excellent argument — and exactly where it’s needed.