President Barack Obama has admitted what Senator Max Baucus said a month ago: that his Obamacare is a train wreck coming down the tracks. Obama has delayed until 2015—i.e., until after the midterm elections—the implementation of the employer mandate. With this mandate, large employers would have been required to provide health “insurance” for all of their full-time-equivalent employees or face a fine of $2,000 per employee. (Note that the existence of that fine puts a floor under the per-employee cost of insurance of some $2,000 per covered employee.)
No one was ready for employer mandate part of the train wreck. Not the employers, although they have been variously cutting back on employees, employee hours, and/or hiring in order to hold their numbers to a bearable cost. Not the IRS, which quite apart from the criminal aspects of its operation is wholly unprepared—employees or software—to manage its tracking and enforcement task. Not HHS, which hasn’t even been able to write draft rules good enough for comment, much less for publication.
This represents a golden opportunity for the Republican Party. They were handed a gift by the Supreme Court in the summer of 2012 when that body upheld the constitutionality of Obamacare. Had it been struck, the Republicans would have been caught flat-footed with no viable alternative, and the Democrats would have had a field day beating them about the head and shoulders for being whiners without a solution.
Now’s the chance for the Republicans to recover from that unpreparedness. In addition to voting to repeal Obamacare one more time, the House has from now through late summer 2014 to pass an actual alternative to Obamacare. Such an alternative might be three bills: one to take down barriers and allow health insurance to be sold interstate, with no mandates for minimum coverage. Let the doctors, patients, and market decide what policies (and there will be a lot of them) should be available, and a policy available for sale in New York ought to be saleable in California, also; only the market should make that determination, not any Know Better Government. Moreover, these policies should be saleable for risk-based premiums, not community premiums. One group of Americans should not be forced to subsidize another.
Another bill could be a sort of Truth in Advertising bill. The House should pass a standard, plain English language policy format that mandates that each item to be covered or excluded is to be described in these terms, so that a potential insuree (and his doctor if desired) can compare policies from different insurers and be able to understand the tradeoffs he’s getting when he selects one policy over another. All without having to talk to an insurance agent for the explanation (or even to view the policy at all), unless the insuree wants to. This bill might also give the health insurance industry two years (say) to come up with their own standard language, or the House-passed format will go into effect.
A third bill could involve the health provision industry. This one might center on the publication of performance statistics by hospitals and doctors: admission lengths vs readmission rates vs regional averages, surgery types vs success rates vs regional averages, treatment types vs re-treatment rates vs regional averages, and the like.
Senate Republicans should take up the matter, too, and either work to force a Senate (roll call) vote on their version or work to force a Senate (roll call) vote on the House version when it comes up. Of course either version will fail in the Senate, and we can anticipate Obama veto threats, too. But the Republicans will have the Democrats, in the runup to the 2014 midterms, on the record, ideally by name on the failed votes, as opposing serious, material health care reform. Those Democrats can be called to account for their demonstrated preference for a train wreck that their constituencies—we Americans—have broadly and volubly disliked since before Obamacare was enacted. We’ll also know who the RINOs were that contributed to blocking these reform bills; they can be dealt with in the primaries.