• Home
• TMR Blog
• Subscribe
• Search
• About
• Contact
• Calendar

With ObamaCare on life support and purely market-driven ideas dead on arrival in Washington, it’s time to think anew about health care reform. Unlike 1994, there is now near universal agreement that we have a health care problem. But, it seems, we are no closer to a solution today than we were 15 years ago.

To garner public support, health care reform must adhere to the K.I.S.S. principle – Keep It Simple Stupid. To find an elegant solution, you must first correctly diagnose the problem. In health care, we have two primary problems.

First, we have too many uninsured – but for many different reasons. Some Americans go without health insurance for a very short period because they are between jobs. Others have enough money to buy health insurance but refuse to do so. A substantial number of young people go without health insurance because they feel they are invincible.  Still others are unable to obtain insurance because they do not work for a business offering insurance and have a pre-existing condition.

Second, the cost of health care is rising too quickly. In the past decade, the average employer-based health insurance premium has risen at four times the rate of inflation.

Though our health care system has complicated problems, the solution need not require 1,000 pages of legislation like the current Democratic proposal. Nor must it come through a thousand paper-cuts like the current hodge-podge of Republican proposals. 

Instead, we can build on a system that already works: the Federal Employees Health Benefits program. Today, federal employees enjoy more health insurance choices than the vast majority of Americans. Insurers compete directly for federal employees on price and quality. For example, in Missouri, federal employees have their choice of 10 plans available nation-wide or 10 state specific plans, and rates are good because insurers have access to a large pool of employees.

Congress should build on this structure, with seven inter-related, yet simple reforms.

First, allow every American citizen access to the federal employee health insurance pool.

Second, increase the size of the pool to guard against adverse selecton by requiring all public entities receiving funds from the federal government to make the pool available to its employees.

Third, transform Medicaid into a market-based program by providing recipients with subsidies they can use to purchase plans within the exchange, and providing mechanisms to encourage them to pick cost-effective plans.

Fourth, fix the problem for people between jobs by allowing all plans purchased within the exchange to be tax-deductible, regardless of whether purchased by an employer or individual.

Fifth, allow all individuals who buy a plan within the pool to keep their plan if they later become employed by an employer providing health coverage, and require that the new employer pay the same benefits to the pool coverage as it does for its own employees.

Sixth, fix the problem for people with pre-existing conditions by prohibiting insurers in the pool from refusing coverage based on health status, but allowing them to charge a reasonable surcharge on premiums for such individuals.

Seventh, require all insurers offering plans in the pool to also offer a catastrophic option with low premiums and high deductibles. This will encourage consumers to save money.

Both Democrats and Republicans would have problems with this plan. Democrats won’t like that it uses vouchers for Medicaid, isn’t heavy with mandates, and does not create a public option to compete directly with private plans. Republicans won’t like the regulations on pre-existing conditions or the mandate that business pay equal benefits to employees in the plan and employees on a company plan.

But as Mick Jagger once said, “You can’t always get what you want. But if you try sometimes, you just might find, you get what you need.”  

Jay Barnes is an attorney, Realtor, and writer from Jefferson City, Missouri. He has previously served as General Counsel for the President Pro Tem of the Missouri Senate, Policy Counsel and Chief Speechwriter for Missouri Governor Matt Blunt, and Policy Director on Kenny Hulshof's 2008 campaign for governor.  He also serves as a director for Missourians for Responsible Government, which publishes this site.