Now that the Affordable Care Act's subsidies have kicked in and millions have supposedly enrolled in exchanges, much is being said about Republicans backing away from repeal and replace. I would propose a more honest and accurate phrase about what comes next: rescue and recovery.
In short, our goal shouldn’t be to sink the ship that is the ACA but to rescue people from a ship that is already sinking.
While I share the goal of repeal and replace -- few fought harder to prevent the ACA from passing than I did -- it would be disingenuous for candidates in 2014 to promise to undo a health law that President Obama will defend as long as he's in office. What candidates can and should do, however, is speak in clear and specific terms about the choices voters face in health reform alternatives and describe why a rescue and recovery effort is so essential.
Of course, Obama claims the ACA is a settled matter, but that is far from true. Politicians like to declare The End of Ideological History when their preferred ideas become law, but history rarely cooperates. In a free society, free people and their elected representatives constantly reshape existing law. When it comes to the proper role of the market in health care, the debate is only beginning.
The ACA has many flaws, but its two fatal ones are the ways in which it increases costs and limits choice.
In terms of cost, premiums have increased by more than $2,500 per family since Obamacare passed. If $2,500 sounds familiar, that’s because it was the amount the president promised to save families. In other words, Americans have seen a $5,000 swing in the wrong direction. That’s not the kind of change voters had in mind.
Meanwhile, the costs of deductibles and premiums — big, out-of-pocket expenses — have soared more than 40 percent in the individual market in the past year. Because the ACA relies on government mandates rather than market forces, premiums will likely increase even more over the next two years. Compounding these increases is the fact that young, healthy people aren’t enrolling fast enough to offset the costs of covering older, sicker patients.
On the choice front, the ACA reaffirms my axiom that access to government health care programs does not guarantee access to health care. It is one thing to promise universal coverage, but quite another to help patients actually see a doctor and receive quality, affordable care. Giving people the option to buy health care they can’t afford isn’t progress. The fact is the ACA’s cost increases are already limiting choices across America.
And we haven't even seen the full force of the ACA's de facto rationing provisions. The law empowers panels like the United States Preventive Services Task Force -- which foolishly suggested breast cancer screening should start at 50 rather than 40 -- to make life and death recommendations about coverage. As a result, patients may lose not only their doctors, but also their treatments.
ACA enthusiasts argue that when people hear about the law’s range of provisions, they like the law more than they did before. But in the normal person’s hierarchy of needs, cost and choice trump any other provisions that Paul Krugman and other liberal luminaries find important. As James Carville might say: When it comes to health care, it’s cost and choice, stupid.
But understanding the ACA’s flaws is only the first step. The next step is to spell out why an alternative would be superior.
The plan I recently introduced with Sens. Richard Burr, R-N.C., and Orrin Hatch, R-Utah, called the Patient CARE Act, will do everything Obamacare promised to do with less cost and better outcomes. A few key provisions:
• Individual Americans have the freedom to shop for their own health care through a means-tested tax credit that helps lower-income people the most.
• The plan adopts policies that will make the market more transparent, competitive and responsive to consumer demands. Our society trusts the market in every area except health care and education. That needs to change.
• Health savings accounts will be expanded, allowing consumers to keep more of their dollars for their health care needs.
• States have greater responsibility and accountability for designing Medicaid solutions that work for their own state without blowing a hole in the budget.
• The plan puts the brakes on the practice of defensive medicine — another driver of health care costs — by suggesting medical liability reforms.
• Solve the pre-existing condition problem by creating a new continuous-coverage consumer protection that allows people with coverage to move onto a new plan without being medically underwritten for a new plan.
Simply put, our Patient CARE Act highlights the real choice: the one between the ACA's government-centered coercion and the individual patient's personal choice and freedom. Markets aren't perfect, but history shows that nothing distributes scarce resources more fairly and efficiently. We've tried the government-centered approach. It isn't working -- just look at the Department of Veterans Affairs. It's long past time to put patients in control and let freedom work.
Tom A. Coburn, M.D. is a U.S. senator from Oklahoma and a practicing physician specializing in family medicine, obstetrics and the treatment of allergies.