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.
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