We Get Results: A Republican Plan

Yesterday, Global Review published a complaint that Republicans have squandered the opportunity to offer a clear alternative to the quasi-socialization of medicine.

We complain, they respond. Congressmen John Shadegg (R-AZ) and Pete Hoekstra (R-MI) have an excellent policy memo in the Journal today, laying out clear rationale and a smart plan for reform.

Thousands of foreigners come to America to get care each year; in 2008, some 400,000 people traveled here for treatment... The problem is that some in America cannot access this care. Republicans and Democrats agree that we should cover all Americans.

They highlight cost control, pre-existing conditions, and non-insured Americans as the key areas of reform. The most interesting feature was the GOP approach to the pre-existing condition problem:

In 2006, the Republican Congress and President Bush passed legislation encouraging states to create "high-risk" pools where those with pre-existing conditions could receive coverage at roughly the same rates as healthy Americans. State-based high-risk pools spread the cost of care for those with chronic diseases among all insurers in the market. The additional cost of their care is subsidized by the government.

Unfortunately, some states have not created high-risk pools, and some need to be restructured to ensure timely access to care.

This system has been insignificant so far because the market for health plans remains uncompetitive; the first part of Shadegg & Hoekstra's proposal would start to address that problem.

The congressmen also propose government vouchers spent by low-income consumers in the marketplace as a means of covering the uninsured. This certainly seems to me the most sensible idea (it's similar to how Medicaid works in some states), and it would give the poor access to the same health care as the rest of us.

This brief article doesn't go far enough in describing how means-testing would work for the new Medicaid, or whether penalties would be levied against people who want to slide by without health insurance.

Nor does their proposal for increasing competition by removing the self-insurance penalty seem like it will be enough to actually get competitively priced individual plans. I think that it's probably necessary to do away with employer-provision altogether, and put the onus on consumers to buy their own health insurance - just like they buy their own car insurance and home insurance.

The next step for Shadegg, Hoekstra and friends is to take the message beyond the friendly readership of the Wall Street Journal. The best way to move beyond the Town Hall anger of August and resolve the public debate over health care is for voters to see some alternatives and be able to choose among them through their elected representatives.