The coming debate over health careI'm encouraged that Colorado is finally discussing some genuine free market health care reforms.
No matter who wins the Democratic presidential nomination, that candidate will have a significantly different prescription for the nation's health-care system than Sen. John McCain, the Republican nominee. Which is a good thing, since that means the country is in for a debate involving real substance.
Both parties agree that "the health system needs major repairs," reports Kevin Sack in a recent analysis of the candidates' proposals by The New York Times. As Sack noted, the Democrats are more interested in universal coverage, while the Republicans focus on cost containment.
Those may be the points of emphasis, but McCain wants expanded access, too, while Barack Obama and Hillary Clinton claim they can rein in health-care costs. One thing we've learned from state-based experiments in universal coverage: It's not cheap. In Massachusetts, taxpayer subsidies for its two-year-old program of mandated coverage will rise from $158 million in 2007 to $600 million this year and $870 million in 2009. Lawmakers are now scrambling to impose new cost controls. On the menu: lower payments to doctors, hospitals and drug companies.
Meantime, a similar plan proposed in California died in January when the independent Legislative Analyst projected the program would cost at least $4 billion more in its first five years than proponents first suggested.
By contrast, McCain's agenda would primarily expand choices for consumers. Among other things, he would allow Americans to purchase health coverage from a licensed insurer in any state; individuals could shop nationwide for an appropriate policy and compare prices. He would also allow membership organizations (like AARP) or other non-employers to sell group policies.
Most dramatically, he would end the tax deduction that employers receive for providing health insurance; instead, individuals would receive tax credits they could use to either purchase policies or invest in Health Savings Accounts. They would no longer depend on their employers for medical coverage.
Taken in combination, these proposals would give individuals more control of their health-care options..
Until the next president takes office, states would be well-advised to steer clear of comprehensive reform. But they can act on the margins. Indeed, we're encouraged to see several consumer-friendly initiatives in this year's legislature. House Bill 1061, with bipartisan sponsors, has passed both houses and would allow advanced practice nurses (who have specialized certification, such as in clinical practice or anesthesia), to provide a broader range of care - more like physicians.
Next, House Bill 1311 would establish two new, bare-bones insurance plans for any employer that does not offer its workers medical insurance. The proposal died in committee, but the lead sponsor, Rep. Spencer Swalm, R-Centennial, told us that House Speaker Andrew Romanoff has expressed interest in reviving it.
Finally, House Bill 1327, from Rep. Cory Gardner, R-Yuma, would allow Coloradans to purchase insurance from out-of-state providers if a group of states set up a market for such policies. McCain's plan does not have to be law for this bill to take effect.
HB 1327, scheduled for a committee vote on Monday, offers another example of an incremental reform at the state level that could expand choices and contain costs. We encourage more efforts along these lines.
Such free market reforms are good because they respect an individual's right to spend his own health care dollar according to his judgment, for his own benefit. In contrast, false "reforms" (such as expanding Medicaid or imposing insurance mandates), merely raise costs, decrease access, and force more people to become government dependents, as has happened in Tennessee and is happening in Massachusetts. Bureaucrats then decide how and for what people's health care dollars may be spent, not the individual patients and doctors.
The debate is finally starting to shift in the right direction.