Now that the federalization of health insurance, which was
approved by a liberal Democratic Congress in 2009 and signed into law by United
States President Barack Obama and is also known as “Obamacare,” has still not
been repealed, a few thoughts on the issue of government health insurance
policy are timely.
Obamacare
federalized health insurance by making it a federal requirement that people
purchase health insurance and for large employers to provide coverage for their
employees, as well as requiring certain benefits and coverage eligibility and
prohibiting the denial of health insurance for pre-existing conditions. The federalization of health insurance also
includes a complex system of regulations.
However,
health insurance is not generally a federal issue. Therefore, there must be a transition away
from federalized health insurance back toward private health insurance
regulated by the States, not a replacement with some less-burdensome federal health
insurance regulation regime. The
transition must be done in such a way that people do not lose their health
insurance coverage through government actions.
It is not a federal responsibility to provide health care or health
insurance or to require health insurance, but the federal government ought not to
harm people by causing them to lose coverage through no fault of their own, such
as has happened because of Obamacare.
It is
necessary to transition away from federalized health insurance not only because
of a lack of constitutional authority for it, but because the system is flawed
in every way: it has caused some people to lose the insurance plans they liked,
some of whom have not been able to find replacement coverage, has increased
health insurance premiums and deductibles, has increased taxes and limited
freedom, has come between the doctor-patient relationship by substituting the
judgment of bureaucrats for that of doctors, has caused some patients to lose
the freedom of choice of medical providers and has increased to the federal
budget deficit. In addition, because
employers have been reluctant to employ more than 50 full-time employees, which
would meet the threshold for Obamacare, the federalization of health insurance
has retarded employment growth and thus economic growth, which, in turn, has
reduced tax revenues. All of these
results have come in exchange for minimal positive tradeoffs in terms of
improved coverage, as millions of Americans remain uninsured, the supposed
problem of which was the excuse for the heavy federal regulation of health
insurance. Obamacare is essentially a
wealth redistribution mechanism and a political tool for politicians to provide
more largess and control more areas of peoples’ lives.
Most Americans had liked their
health insurance before Obamacare. The
many who were not covered either did not believe in health insurance for
religious reasons, were wealthy enough not to need it or were young and healthy
and calculated the cost of coverage was not worth the expense of the premiums,
not because of some economic difficulty or some cruel neglect by
government. Some problems, such as the
high cost of medical practice insurance, defensive medicine and overspending by
patients, that led to higher healthcare and health insurance costs were
unaddressed by Obamacare. Obamacare also
mostly fails to incentivize healthier choices by patients.
In addition to eliminating federal
requirements to purchase health insurance and for employers to provide it for
their employees, the federal government should decouple health insurance from
employment in terms of tax policy. Health
insurance benefits should be taxed like any other income, instead of being the
exception, which would inform employees of the value of their health insurance
and discourage overspending for unnecessary matters and encourage healthier
choices. It would also be fair to those
whose employers do not provide health insurance. At the least, the U.S. should provide proportional
tax breaks for those whose employers do not provide health insurance, as a
matter of fairness.
The federal government should
eliminate Medicaid, a federal welfare program, or at least reform it to make it
less unappealing to medical care providers and less expensive. One way to accomplish these goals would be to
block grant Medicaid money to the States and give them the flexibility to
reform Medicaid, which would at least be less violative of the constitutional
principle of federalism.
Federal and state tort reform would
address the high cost of healthcare because of the high cost of medical
malpractice insurance and discourage defensive medicine.
With the return of health insurance
to the States, free market principles, such as competition and freedom of
choice between insurance plans and medical providers, should be followed, as well
as the doctor-patient relationship restored.
Covering patients for their
pre-existing conditions is not health insurance. This provision of Obamacare is not one of its
“good” parts, despite its popularity and the phony moral case made for it. It is a corruption of the language and an
abuse of health insurance. Such patients
should not lose coverage for other medical needs, but health insurance
companies should not be mandated to cover patients for an illness the patients
already had. Instead, it should be more
difficult for people to lose coverage in the first place, which should be more
portable generally. Those left uninsured
can be helped in other ways than by destroying health insurance.
Medical providers should provide
health care for emergencies, as is legally required, and then bill the patients
who do not have health insurance or who lack adequate health insurance. Perhaps better methods of payment collection
could be authorized or made less unappealing, if necessary.
Relatively less-expensive catastrophic
health insurance should be encouraged, especially for those who are younger and
healthier.
As was the case more before
Obamacare, healthy choices by patients should be incentivized with lower health
insurance premiums.
The federalization of health
insurance can be repealed and replaced with market-based state-regulated health
insurance plans that address all the problems of health insurance, especially
the cost, and that increase the freedom of patients, with less burden on the taxpayers.