Obama’s Healthcare Plan: What’s The Alternative?
MICHEL MARTIN, host:
We turn now to Thomas Miller. He's a former senior health economist for the Joint Economic Committee in Congress. He's currently a resident fellow with the American Enterprise Institute. And he's involved with an AEI series called Beyond Repeal and Replace: Ideas for Real Health Reform. And he's with us now.
Welcome to you. Thank you for joining us.
Mr. THOMAS MILLER (Senior Health Economist, American Enterprise Institute): Pleasure to be with you today.
MARTIN: So, why repeal? Just pick up the ball there. Just pick up where Mary Agnes left off. Why repeal?
Mr. MILLER: Repeal is a good start. It's not a finish. This was a terrible law that was cobbled together and pushed through just barely, wheezing and gasping, when popular support for it had already evaporated. And it's time to move on. It's unfortunate that we wasted a couple of years, because we do need health care reform, just not this version. And there are multiple reasons, whether it's the overall cost, what it does to the equality and value of the rest of the health care system, the crushing burden of regulation.
What really this leads us toward is much more of a politically dominated approach to health care, as opposed to people finding the choices they would like. So we need to do better. Unfortunately, first, you have to get something out of the way before you can get back to having the debate we didn't really fully have to get the voice of the people who weren't(ph) really expressed.
MARTIN: OK. Well, I do want to spend most of our time talking about what you think is a better idea, but just briefly, if you would, do you agree with Mary Agnes' analysis that this is really unlikely in the next - that repealing is really an unlikely scenario in the next few years?
Mr. MILLER: Passing it was really unlikely a couple of years ago, as well. Things surprise you. I would agree that by conventional wisdom and the current projections, the votes are not there in the Senate, and certainly President Obama hasn't changed his mind yet. On the other hand, a couple years ago, people wouldn't have thought he would be supporting across-the-board tax cuts, or at least the preservation of the tax cuts that existed.
MARTIN: Or tolerating it.
Mr. MILLER: Politicians have a way of changing their mind, not maybe internally, but they'll do what's necessary if the larger opinion climate has changed. So a lot of what's going on is to redirect the way people think about this health care law and health care reform and to change the tectonic plates so that things move differently, and politicians will adjust. They'll get in front of whatever parade is going on.
MARTIN: Well, clearly this is not the only conversation we're going to have about this, because this is such a priority for particularly the House Republicans. So just start us off, if you will, Mr. Miller - what's your better idea? Well, tell us what's wrong. You only have three minutes here.
Mr. MILLER: We don't have enough time.
MARTIN: We don't have enough time. We only have, you know, a few minutes. But tell us what's what's the most what's the thing that's most wrong and tell us what's a better idea.
Mr. MILLER: What's most wrong is despite the rhetoric, this is not a health care system trying to be established, which is about people having more choices, a chance to express their values, their preferences, and find the health care that they can pay for and afford and are willing to seek. This is a highly regulated, politically dominated approach to health care - on the way toward more of the same. And it's not going to work just administratively and then practically, at great expense.
And we haven't fixed the problems we really have, which is - they're in Medicaid, they're in Medicare, and the rest of the private health care system as well. That's it in a nutshell.
Some particular things - the individual mandate won't go into effect. It's not going to fly in American society. The current penalties are fairly weak. It's the bailing wire that tries to hold this together that doesn't work. There's a wave of regulation being imbedded right now. Be hard to pull that up entirely. But again, it makes no sense. We're going to drive competitors out of the marketplace. We're going to take away choices from people in the name of giving them something that someone else thinks is good for them.
MARTIN: You have a minute and a half left. So give me your three best - better ideas.
Mr. MILLER: Well, the big long-term idea which we've put out is the idea of an integrated approach to defined contribution for all taxpayer subsidies, whether it's in Medicare, Medicaid or for private health insurance, largely through your employers, to begin to redirect those subsidies so they make some sense. They're not unlimited. Let's help the people who are most vulnerable, need the most help, but we have to get some better signals as to what things really cost.
MARTIN: So it's kind of like moving from the pension system to the IRA system.
Mr. MILLER: That's the analogy.
MARTIN: It's moving from defined benefit to defined contributions.
Mr. MILLER: It's very easy to promise something without having to pay for it. We're finding out in the pension system that doesn't work, particularly local governments are hitting that right now. Same thing is ahead of us in terms of health care, most seriously in Medicare. But ultimately a little, you know, thimble full of the change with what's called the Cadillac tax - not going to work, it's put off for 10 years from now. Incentives are all wrong on it. So that's one area.
There were a lot of other things that we've had before, talked about, need to drive them through - interstate sale and purchase of health insurance, more competition, more transparency, better reporting on provider performance, rationalizing Medicaid so it's not on steroids but actually deals with the folks who are most vulnerable. We've kind of gone in the opposite direction there. And pulling up a lot of these weeds of regulation, having a much more transparent, honest system.
MARTIN: Well, you've given us a lot to think about and talk about. And I think, we will be thinking and talking a lot about this in the weeks and months ahead, especially if the Republican leadership has its way in the House, and I think they will.
Thomas Miller is a former senior health economist for the Joint Economic Committee in Congress. He's now a resident fellow with the American Enterprise Institute. He's author of a - co-author of a book coming out in March called "Why ObamaCare is Wrong for America." And he'll come back and talk to us about that. Mary Agnes Carey with Kaiser Health News was also with us in our Washington, D.C. studio. Thank you both so much for speaking with us.
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