This difference about what health insurance is has actually been essential to the Left-Right divide on health care, though it hasn’t always gotten the attention it deserves. Liberals have increasingly been willing to acknowledge the growing evidence (though there has long been a lot of evidence) that insurance doesn’t improve health very much but rather provides much-needed financial security, but they have yet to allow this to reshape their basic view of what insurance ought to look like and what is really essential about it. Proposals like the one Walker put forth today are built on an answer to that question: everyone could afford at least catastrophic coverage if they wanted it, and beyond that there would be a competitive market in additional coverage and care. Meanwhile, Obamacare, because of the narrow space it provides for varying insurance design, has been yielding a lot of insurance products that look like upside-down insurance: very high out of pocket costs (often higher than what a pre-Obamacare catastrophic plan would have involved) coupled with extensive minimum coverage requirements, so that routine care is covered by insurance but unexpected calamities create financial disasters. Not surprisingly, such products turn out to be pretty unattractive. Flipping that model around would make for much more sensible insurance.
An approach like the one Walker laid out today would be a huge step in the right direction. The problems with the health-care system that preceded Obamacare called for a move to the right, not to the left—toward provider competition and consumer choice, not centralized prescription and expert management. This proposal offers such a move, going well to the right not only of Obamacare but also of what came before it.
It’s not the only way to improve the health care system, and other candidates will surely present their own approaches to conservative health-financing reform (as a couple already have). But this one sets the bar for conservative health reform very high, in both substantive and political terms. Let’s hope more candidates reach that high.