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    Announcing "A Health Care Contract With America"

    Critics say FreedomWorks and other ObamaCare critics "spend all their time opposing the president's health care reform, but don't have any alternative, better ideas of their own."

    Not true!

    I've been in Washington health policy circles for two decades. During that time, I've seen grassroots conservatives and libertarians generally coalesce around a very robust set of health care reform principles and proposals.

    Four years ago, I tried to compile a comprehensive list of them -- not just the most popular, but every idea, large and small. I stopped after finding more than 125 distinct ideas, certain I'd probably missed quite a few. Some of the ideas were better than others, but the sheer length of the list proved to me that conservatives and libertarians do in fact have their own alternative ideas for fixing health care. Some Republicans are too topdown for my tastes, favoring a "premium support," managed-competition approach like RomneyCare. But the majority of Republicans seem to be more favorable to bottom-up, consumer-driven, patient-centered approaches.

    Patient-centered care means patients and doctors are in charge instead of politicians and bureaucrats (and that's regardless of whether the bureaucrats are public or private). It leaves people free to save for their own health care costs and pay their own way as much as possible. Ultimately, people paying directly for their own health care, rather than through third parties, is the only way to get costs down and more people covered without bureaucratic rationing.

    For years, FreedomWorks has urged ObamaCare opponents in Congress to enunciate very clearly what they are “for.” We've also advocated our own reform ideas. We've now pulled what we regard as the most important ideas into a single, easy-to-understand set of principles.

    Here is what FreedomWorks is for:

    A Health Care Contract with America

    1) Allow everyone to maintain his current health insurance. No exceptions.

    2) Treat everyone the same. No special treatment for Members of Congress, unions, businesses, etc.

    3) Allow people to opt out of federal health insurance benefits, without penalty.

    4) Allow people to own their own medical insurance and take it with them from job to job.

    5) Allow all taxpayers to receive tax deductions for medical expenses, including personal Health Savings Accounts.

    6) Allow insurance companies to compete across state lines.

    7) Help people with pre-existing medical conditions, through significant transitional block grants to states rather than mandates.

    8) Provide all citizens advance knowledge of their health care costs (excluding medical emergencies).

    9) Provide reasonable maximums for “pain and suffering.”

    10) Avert Medicare’s bankruptcy by providing fewer benefits to the wealthy.

    11) Allow the elderly and all doctors the choice between private insurance and Medicare. 

    12) Eliminate first-dollar coverage. Everyone should have some skin in the game.

    These twelve principles would inject much-needed “patient power,” choice, and competition into the system.

    • If people want to have the richest, most expensive health insurance around, why, they should be free to obtain it -- with their own money.
    • If people want bare bones coverage, they should be free to buy that.
    • If people want no insurance at all -- to "go bare" and just rely on their own savings and family and friends -- they should be free to do that.
    • If people want to buy individual rather than group coverage, they should be free to do that.
    • If seniors want to pay doctors outside of Medicare's price controls, they should be free to do that.

    In other words, people should be free. 

    I think this plan balances boldness with achievability.

    It doesn't fundamentally change "safety net" programs like Medicare and Medicaid in such a way that the Left can easily mischaracterize the reforms as "harming" people. Instead, it plants seeds of freedom that, if allowed to thrive and grow, will produce improved conditions for reforming the "safety net" programs in the future.

    If implemented, this "Health Care Contract" would lower health care costs and improve access to care -- and thus reduce the number of uninsured Americans -- by voluntary rather than coercive means.

    We know this reform plan will work, because we know freedom works. 

    Dean Clancy, a former senior White House budget official, is FreedomWorks' VP for Public Policy and a specialist in US health care reform policy.

     

    [UPDATE (10-24-2013): The original version of the "Contract" contained only ten planks. I've expanded  it to twelve, in response to thoughtful reader input.]

    [UPDATE (10-31-2013): I've just discovered there's another 'Health Care Contract with America" out there that's very similar to ours. It was issued last year by economist John Goodman of the National Center for Policy Analysis, whom I've always admired. I am more than happy to give him full credit for coming up with the label "Health Care Contract with America." But it's too good for me not to keep using it!]

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    Announcing a Health Care Contract with America

    Patient Centered Care: The Future Is Now

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    10 comments
    Chris Rankin
    10/19/2013

    Let's face it, D.C. just can't do anything right anymore, not even the military, they're screwing that up now.
    Anyway, how to reform healthcare...my thoughts.
    Clean up Medicaid and Medicare (eliminate fraud, waste and abuse, by the bureaucrats actually doing their jobs - impose accountability). Open MEDICAID up to all (single payer) but with a means test and scaled monthly premiums for those above specified income levels. Allow it to compete with commercial insurance nationwide. Couple this with common sense tort reform (screw the lawyers and allow docs to do common sense diagnostics) and mandate that ER's be able to triage non-emergency patients right back out the door with NO liability consequences.
    Make medical schools tuition free (with government picking up the tab), but only allow them to admit the top 10%-20% of applicants who have to commit to 10 years of salaried public health service after residency. Encourage the rest to pursue careers as PAs, NPs, RNs and other healthcare related fields.
    Eliminate restrictions on commercial insurance availability across state lines.
    Finally, once these policies are firm, the health care industry will rush to adapt by accommodation. Let it and the rest of the private sector operate and adapt without crushing regulation and oversight. At all costs, let the market work.
    BTW: and completely off the subject...did you realize that during the shutdown, we had a balanced budget government! Think about it.

    Edwin Loftus
    10/18/2013

    Don't have any federal program or regulation and allow each state to determine its own system. Some may return to the free-market system before Congress started giving tax-breaks to employers for offering health insurance benefits. Some may use Obamacare as a model.
    States already forge or don't forge agreements to honor other state's rules and that could include cross-state sales and transfers.
    The people in each state can decide whether to require pre-existing condition coverage, provide a state fund to cover such issues or not provide for this and leave it to individuals to negotiate or move to a state with policies they like more.
    States that develop the best solutions will prosper and people and their movable resources will seek them out. States with the worst solutions will decline and people will move away. Declining states will look to the examples of prospering states and copy them and in short order we will have better systems everywhere because we have not tried to impose solutions from above.

    Joe Grimes
    10/18/2013

    How about a single payer system where we eliminate the over head costs that private carriers must maintain? How about measuring performance, that is outcomes? How does the current system stand up compared to that of most other industrialized nations?

    Lisa Miller
    10/17/2013

    I'm confused, why are you still broadening entitlements thru this pre-existing condition block grant?

    Why no stripping out of mandates so those with pre-existing conditions can obtain affordable insurance AND affordable services?

    Why dictate a policy feature when the consumer should choose the benefit features and the market has the ability to write innovative policies to address customer needs?

    Allow insurance companies to compete across state lines AND avoid that State's mandates.

    Consumers should be able to chose between tort and arbitration and have the cost and/or savings reflected on their bill.

    Providers should be able to do charitable work under arbitration automatically.

    And I've MANY more ideas Washington has NOT thought of.

    Lisa Miller

    Dean Clancy's picture
    Dean Clancy
    10/31/2013

    I'm scratching my head as to why Karen Huston criticizes me for an "offensive," "Kingdom of the Beltway" tone? Was it because I opined that preexisting medical conditions is a problem that, as a practical political matter, we can't avoid dealing with? If so, all I can do is remind the reader that the ObamaCare's preex mandate is the law's most popular provision. That's why I think the burden of proof is on those who say "Just repeal it," and not on those who say, "Replace it with something less problematic, temporarily." I think there are only three options available here: (a) repeal the preex mandate; (b) keep the preex mandate: and (c) repeal it but spend some money temporarily to help smooth the transition. Option (b) is unacceptable as a matter of principle, in my opinion. I assume (a) is politically impossible at this time. If I thought (a) was doable, I'd be wholeheartedly for it. So that leaves (c). If it is, as I suspect, the only option that can garner enough votes to pass, then I'm sorry but I think the prudent thing is to support (c), so we can move closer to our end-goals, which are to thwart ObamaCare in the near term and repeal it in the long term. P.S. The feds currently spend tens of billions of dollars every year on subsidies to low-cost clinics and hospitals. These entities were named by Ms. Huston as an alternative to either a mandate or a transitional block-grant. I would like to agree, but I don't think you can get the votes by pointing to those subsidies and saying, "That's sufficient." We will, I predict, have to create yet another subsidy stream, in order to further our goal of eliminating ObamaCare. Such is the maddening nature of practical politics in the Kingdom of the Beltway!

    Lauren DeLuce
    10/18/2013

    It's never too late. The plan in place isn't going to work. Nice thought, but let's get back to reality. I don't want to be a Medicaid patient, and neither do you. I'm a nurse, so this hits me on a personal and a professional level. Everyday it seems like a new requirement is implemented, and it is unnecessary. Legislators should NOT be telling me, or the people I work with how to do our jobs. It is costly and inefficient. Your making my job even harder. You think it's just the MD's that are upset? Wrong. I'm not staying in the field either. So, awesome!!!!! Everybody is "covered", but good luck trying to use it.

    stonestone's picture
    stone stone
    10/18/2013

    The GOP had every chance in the world to introduce their own version of a healthcare plan. They had over three years to do so. Instead they fought tooth and nail against ANYTHING that remotely smelled like healthcare. They lost. Why? Because they let their party become dictated by the "Tea Party", which in itself is a manufactured astroturf mechanism that has nothing to do with the people and everything to do with its corporate founders. They- along with the GOP they use- lost and nearly crashed the economy in the process. Want your own heathcare plan? Too late. You had a chance, and that chance was squandered.

    Karen Huston
    10/17/2013

    Excellent, Lisa. It seems that conservatives have gotten caught up in arguing healthcare reform in the context of Obamacare and have forgotten the free market principles and reforms that would truly address the cost of healthcare. You're an exception. I'm relieved.

    Dean, your ideas "allow" Americans to do this, or have that? We are grownups, Dean. Your choice of words sound very Kingdom of the Beltway to me. Offensive.

    I think government has a role in providing a safety net for those who need it. Wouldn't a low cost, to the consumer, clinic or hospital be less expensive for preexisting problems, or low income individuals? It seems like eliminating the middle men of insurance companies and government agencies would reduce taxpayer costs.

    Karen Huston
    10/17/2013

    Excellent, Lisa. It seems that conservatives have gotten caught up in arguing healthcare reform in the context of Obamacare and have forgotten the free market principles and reforms that would truly address the cost of healthcare. You're an exception. I'm relieved.

    Dan, your ideas "allow" Americans to do this, or have that? We are grownups, Dan. Your choice of words sound very Kingdom of the Beltway to me. Offensive.

    I think government has a role in providing a safety net for those who need it. Wouldn't a low cost, to the consumer, clinic or hospital be less expensive for preexisting problems, or low income individuals? It seems like eliminating the middle men of insurance companies and government agencies would reduce taxpayer costs.

    Dean Clancy's picture
    Dean Clancy
    10/17/2013

    Lisa, thank you. All very good points. You are working from very sound principles. And our ultimate end-goals are, I suspect, very similar. I will only address your question on the preex issue. Four things: 1) The plan represents some compromises with what I regard as political reality. I fully understand if other principled people differ in my political assessments. 2) The block grant would be to fund existing state high-risk pools. I didn't include the term "high-risk pools" in the language of the ten points, but maybe I should for clarity. They'd also be transitional -- sunset. The idea is to get the states to step up, so we can facilitate the repeal of the current, truly destructive federal guaranteed issue and community rating requirements. 3) I think preex is the hardest nut to crack, politically -- but the most important nut to crack. It's the one issue we HAVE to address, in some concrete way, if we want to be taken seriously on any kind of health care reform. Look at how elected Republicans always tend to endorse the guaranteed issue mandate at the first mention of preex -- they give away the store at the outset! They need a better idea, something they can stand on, something bullet-proof that really addresses the issue and does minimal damage to health care markets. The block grant idea seems to fit the bill. But: 3) I am open to any other approach that would be equally concrete and effective in terms of policy and providing that political bullet-proofing I mentioned. Anyway, that's what I think. Thanks again. And please keep those good ideas coming!

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