Repeal Is Not Enough

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American Spectator:

Repeal Is Not Enough
By Robert M. Goldberg on 8.13.10 @ 6:08AM

Republicans and assorted conservative policy organizations are beginning to consider how to address Obamacare in the wake of large Republican gains in Congress. In doing so they are careful not to confuse beating a discredited majority with actually governing. This should be particular concern with regard to healthcare. For many pundits and policy wonks, healthcare policy is all about repeal. The results of the Missouri ballot initiative about health reflected opposition not only to the federal mandate to buy coverage. It was an expression of concern that Obamacare is a massive shift of control over every aspect of medicine from individuals to government.

Yet can Republicans be said to truly be governing by, in effect, adding an exclamation point to their opposition to Obamacare? As Michael Barone recently observed: "if they're not in the business in order to shape public policy, why are they there at all?"

Repeal should take the form of believable changes in healthcare. First, Medicare reform should go beyond the accounting gimmickry pursued by past administrations and addresses. A starting point would be changes in financing that encourages less illness, more individual investment in long-term well-being, as well as a phased in increase in the age and income for Medicare eligibility. The last issue will be hotly debated. Meanwhile, Republicans should propose expanding health savings accounts, the popular Medicare Advantage program, and allow people to stay on health plans when they switch to Medicare.

More broadly, Medicare policies should and can sustain what Dan Perry, the CEO of the Alliance for Aging Research, calls, "the longevity dividend," encouraging the use of innovations that slow aging to extend healthy life. Duke University's Ken Manton points out the decline in disability and increase in life expectancy from such innovations could "through increased productivity and labor force participation generate an additional $500 billion in wealth and $100 billion in tax revenues per year between 2018 and 2028." We should encourage work and wealth creation and discourage early reliance on Medicare subsidies. Once on Medicare, we should reward people for getting and staying healthy and not ration the use of such technologies.

Second, repeal should be rightly framed as a bipartisan effort to stop the explosion of unfunded state mandates under Medicaid and the resulting exodus of physicians from the practice of medicine. As Newt Gingrich has observed, it's time to channel Medicaid dollars directly to consumers, promote more preventive approaches to long-term and mental health services and eliminate the welfare stigma associated with the program. Health plans, states and employers should be given more flexibility to link healthy behavior to rewards, as Mitch Daniels has done through his Healthy Indiana Plan. Consumer choice is great. But personal responsibility must be a condition for receiving support for health coverage.