What real health reform should look like
By Paul Ryan
Monday, March 15, 2010; A15
Today, the House Budget Committee is to mark up a "reconciliation" vehicle, initiating the greatest expansion in government and entitlement spending in a generation through a partisan process to push "health-care reform" across the finish line.
Despite claims of transparency and calls for a "simple up-or-down vote," there is nothing simple about this process. This convoluted legislative charade demonstrates how far the Democratic majority has wandered from real health-care reform and cost control, employing any means to achieve political victory.
Through any analytical lens, the legislation will not address the central problem of skyrocketing health-care costs. The Congressional Budget Office estimates that families' premiums could rise 10 to 13 percent; private-sector actuarial estimates top these already high numbers. The higher costs are driven by federalizing the regulation of insurance, narrowing consumers' options and reducing competition among providers. The health-care market would be dominated by government programs and the largest insurance companies, operating as de facto government utilities.
Rather than tackle the drivers of health inflation, the legislation chases the ever-increasing premiums with huge new subsidies. Already, Washington has no idea how to pay for the unfunded promises in Medicare, Medicaid and Social Security -- and creating this new entitlement would accelerate our path to fiscal ruin. When you strip away the double-counting, expose the hidden costs that must be funded and look at the price tag when the legislation is fully implemented, the claims of deficit reduction are as hollow as claims of cost containment.
This legislation includes a range of job-killing tax hikes and controls on all Americans -- to fund this new entitlement and to penalize employers and individuals who don't play by Washington's new rules. The CBO said last July that "requiring employers to offer health insurance, or pay a fee if they do not, is likely to reduce employment." The mix of mandates and higher costs will drive Americans into government exchanges, with an ever-enlarging number reliant upon taxpayer subsidies for their care. The architecture is designed to give the government greater control over what kind of insurance is available, how much health care is enough and which treatments are worth paying for.
The debacle of the past year's "debate" has been a missed opportunity for real reform. Democrats and Republicans alike have put forward proposals that address the drivers of health-care costs, yet they have been ignored in this sharply partisan crusade. House Republicans continue to offer common-sense solutions, with specific legislation. Last May, Sens. Tom Coburn and Richard Burr and Rep. Devin Nunes and I collaborated to address rising costs while securing access to quality, affordable health coverage for all Americans. The Patients' Choice Act takes on the discriminatory and inflationary tax exclusion, delinking the tax benefit from employers and attaching it to individuals through universal tax credits. The tax exclusion for employer-provided health coverage subsidizes insurance instead of health care, hides the true cost of coverage and disproportionately favors the wealthy at the expense of the self-employed, the unemployed and small businesses. Health-care economists across the political spectrum and reform-minded Democrats such as Sen. Ron Wyden identify the backward tax treatment of health care as a problem that must be addressed.
The Patients' Choice Act includes additional reforms -- such as an emphasis on preventive care, medical malpractice reform and interstate shopping -- that could be advanced one at a time in a bipartisan fashion to fix what's broken in health care without breaking what is working.
This year I re-introduced my own proposals to tackle our entitlement crisis head-on. My plan, "A Roadmap for America's Future," fulfills the mission of health and retirement security, lifts our crushing burden of debt, and spurs economic growth and job creation. In stark contrast to the vision being pushed by the majority in Congress, my plan unapologetically seeks to apply our nation's timeless principles -- our Founders' commitment to individual liberty, limited government and free enterprise -- to today's challenges. It does so in a way that honors our historic commitment to strengthening the social safety net for those who need it most.
If this debate had actually been about health care, we could have worked together to get a grip on costs, make quality care more accessible, address exclusions forpreexisting conditions and realign the incentives of insurance companies with those of patients and doctors. Yet this process -- including its embarrassing conclusion -- demonstrates that the debate has never been about health-care policy but, instead, paternalistic ideology.
Should the Democrats' health-care train wreck make it to the president's desk, it will be a pyrrhic victory, and its devastating consequences will take their toll on our health-care system, our budget and our economy.
Paul Ryan (Wis.) is the ranking Republican on the House Budget Committee.