It's Time for Republicans to Rethink Healthcare Policy

Writing in the New York Times, Peter Suderman, features editor at Reason magazine, urges Republicans to start over on healthcare:

If the halting, messy debate over legislation to overhaul health care has taught us anything so far, it’s that when it comes to health care, Republicans don’t know what they want, much less how to get it.

He suggests three principles to guide the rethinking process.

First, give up on universal coverage. I think what he means is give up on having everyone’s healthcare paid in full by the government. I don’t think he means giving up on universal access—the idea that no one should find themselves entirely locked out of the healthcare system.

Second, any plan should include unification of our healthcare system, now a bewildering kludge that is fragmented among employer-based coverage, Medicare, Medicaid and the individual market.


Third, health coverage should be viewed as a financial product, that is, as “a backstop against financial ruin.” For middle- and upper-income households, that means assuming responsibility for routine medical expenses, making it possible to “focus government assistance on the poorest and sickest.”

This should be obvious, and yet it is not. Our system subsidizes workers with six-figure salaries and wealthy retirees while sidelining the poor and the sick with Medicaid, a system that many doctors won’t participate in because of low reimbursement rates.

As it happens, there is a policy option out there that perfectly fits Suderman’s three principles: universal catastrophic coverage. UCC would provide everyone now covered by Medicare, Medicaid, employer-based or individual coverage with an insurance policy that has a deductible scaled to income, say, ten percent of the amount by which household income exceeds the poverty level. That would protect the middle-class against financial ruin while leaving them responsible for routine care; it would largely remove subsidies for top-earners; and it would provide full coverage for the poorest and sickest.

Suderman mentions catastrophic coverage in passing, but, in my view, it should be the centerpiece. Selling UCC would, as Suderman says,

Take a significant investment of time, creativity and study, policy entrepreneurship, and some difficult political and legislative choices. It would require patience and political salesmanship. And it would not result in an immediately popular bill that could easily pass the Senate with 51 Republican votes this summer.

Very true. But then he ends his piece by saying one thing with which I strongly disagree:

[O]ver time [these principles] would distinguish Republicans from their Democratic rivals and give them a positive, productive policy pitch to run on.

That is far too partisan for my taste, and far more partisan that I would expect from the editor of a magazine that has, at least historically, tried to be more than just another cheerleader for the GOP. Instead, I think UCC could, and should, be pitched as a transpartisan compromise with potential to attract support from conservatives, progressives, and libertarians alike.

Reposted from NiskanenCenter.com. Related posts on UCC:

How the GOP Can Win on Healthcare (Niskanen Center)
What a Good Conservative Health Plan Would Look Like (VOX)
A Health Care Plan That Is Universal and Bipartisan (NYT)