The Republican Alternative for Health Care

This is the first draft of my memo to the Republican party on Health Care reform.

It is not enough to be against the President's plan, or the Pelosi plan. The Republicans need an alternative. The system needs reform, but not the non-reform of Obamacare. The country does not need a government solution that is designed "to keep the insurance companies honest". It reminds me of an old joke, the punch line of which is "I'm from the Government and I am here to help you." The country does not suffer from a lack of government agencies. There ARE issues with health insurance, and there are alternatives to address those issues through an open discussion and debate.

The Republicans should lay out their basic principles, just as the President did. But unlike the President, the Republicans should insist on bipartisan debate. Process is important.

The principles:

1. Individual Choice. A fundamental element of the American system is that individuals are free to make their own choices without government interference. Some may choose to go without insurance. If there is to be an individual mandate it should be solely for catastrophic insurance at a limited cost.
2. Insurance should be available to all Americans at a reasonable cost. But we must recognize that insurance is an individual choice and some individuals may prefer to purchase less insurance and use the funds on discretionary items.
3. Insurance should be portable. Someone who has insurance should not be at risk of losing it due to loss of employment. Perhaps this should be an expansion of cobra.
4. Personal Responsibility should be fundamental. There is no rationale that justifies for health care that results from irresponsible conduct such as drugs, smoking, alcoholism or unprotected sex. Also grossly overweight people should not be subsidized by others.

Process

We have the best government in the world. But there is one fundamental weakness. In a system in which congress serves 2 year terms, it is difficult to make long term decisions. the next congress can simply undo what the last has done. Why should a 50-100 year plan be dominated by a party line vote resulting from the unpopularity of the preceding president. To create a system that will stand the test of time, the President should convene a bi-partisan commission including academics and practicing physicians to develop a plan. The social security commission in 1977 is a useful benchmark.