Obamacare is both the mechanism and ultimate manifestation
of what Ronald Reagan described as abstract theorizing of the kind
that turns off the American people. It is the purest expression of
what George Mason economist Donald Boudreaux describes as
“how one group of people (the politically successful)
should engineer everyone else’s contracts, social relations, diets,
habits, and even moral sentiments.”
Hence, in repealing the law it is important for
Republicans and like-minded Democrats to identify and eliminate
those sections of Obamacare essential not only to imposing and
enforcing the view of social engineers who created it
and will profit under it, receiving billions in contracts and
grants designed to centralize medical decisions and rationing care.
Congress should replace these oppressive features with
policies that restore freedom, protect life, and promote
prosperity.
First, Congress should vote to repeal the Patient
Protection and Affordable Care Act and replace it with a
comprehensive bill or super-amendment that meets this goal. (A
combination of tax credits, laws to permit purchase of coverage
across state lines, expanded funding for high-risk pools, and
protection of patients with pre-existing conditions.)
If this effort stalls in the Senate or is vetoed by the
President, Congress should move to eliminate what Senator Mitch
McConnell calls Obamacare’s “most egregious
provisions.” At the top of the list should be any program, agency
or grant the rewards or leads to the replacement of the collective
intelligence of the American people with the decisions of
self-anointed elite. These include:
1. Cutting the budget ($610 million) of the
Agency for Healthcare Research and Quality, the entity that
conducts research on the comparative effectiveness of new medical
technologies, to FY 2008 levels or eliminating it altogether. The
British government is eliminating its rationing agency not only
because it was hurting people and discouraging medical innovation
but because it was duplicating private sector research and unable
to keep up with medical breakthroughs. AHRQ could be eliminated and
no one would notice, except the academics and consultants who both
set AHRQ’s research agenda and get paid for the
research.
2. Eliminate other programs or agencies
designed to centralized medical decision making: That includes the
Center for Medicare and Medicaid Innovation
(CMS) ($10 billion through 2019),
Patient-Centered Outcomes Research Institute (avoiding taxes on
health plans of about $500 million a year), funding for Shared
Decisionmaking and Quality Measurement Development ($75 million).
The new NIH National Institute on Minority Health and
Health Disparities (NIMHD) ($220 million) should be cut because it
duplicates existing research.
3. Programs requiring “such sums as needed”
are slush funds and should be eliminated. For example, the
requirements for grants to establish Shared Decision Making
Resource Centers are tailor-made for CMS administrator Donald
Berwick’s colleagues at Health Dialog, which sells and evaluates
such tools, its non-profit arm, the Foundation for
Informed Medical Decision Making, and the Dartmouth
Hitchcock Medical Center’s Center for Shared Decision Making
(funded by Health Dialog).
4. Eliminate the Independent Payment Advisory
Committee, set up to restrict the kind of care and treatments
Medicare patients can receive.
5. Eliminate or waive medical loss ratio requirements
where are a back door to controlling the definition of what is
medical care.
6. Reaffirm by adding an amendment that bars HHS from
restricting access to what it rules is the “least costly
alternative ” treatment.
7. Eliminate funding to hire 16,000 IRS employees ($1
billion).
In addition, Congress can cut the duplicative pork and
payoffs to special interests embedded in the law: The Prevention
and Public Health Fund ($1.5 billion per year); the mental illness
demonstration grants that emphasize individual wellness ($150
million); the “community wellness demonstration program,” the
“individual wellness demonstration program” and (if you can believe
it) workplace wellness grants ($200 million!). There are
dozens more.
Cuts to restore freedom and protect life should be paired
with reforms that make healthcare coverage immediately affordable,
cut taxes, and restore coverage to Medicare. They
include:
1. Restoring Medicare Advantage funding to 2009 levels so
seniors can keep their current coverage.
2. Restoring hospice funding (the most despicable cut of
all).
3. Extending the tax deductibility of health insurance to
individuals.
4. Expand health savings accounts and flexible spending
accounts (FSA) (breast feeding supplies should be made an FSA
eligible expense!)
5. Make unemployment benefits used to purchase insurance
or medical care tax-free.
6. Allow consumers, regardless of pre-existing condition,
to buy healthcare anywhere (including their place of employment)
with tax credits. (A $3,500 tax credit for 20 million Americans
would cost $70 billion a year, almost 75 percent less than
Obamacare.)
Repeal is not an end in itself. President Reagan said:
“No greater challenge faces our society today than
ensuring that each one of us can maintain his dignity and his
identity in an increasingly complex, centralized society.” To meet
this challenge, Obamacare must be replaced with reforms that
Americans regard as their own.
