By Rep. Paul Ryan (R-Wis.) - 07/16/09 04:38 PM EDT
If it seems as if there is no room for agreement in Washington’s partisan atmosphere, let’s look at some shared principles, and even some shared policy reforms to get there. Democrats, Republicans and independents alike agree on the following goals of healthcare reform: contain costs; expand coverage; preserve the current coverage enjoyed by most Americans.
Beyond these broad strokes, there are some policy prescriptions that would certainly find bipartisan approval if we were communicating in a bipartisan fashion: transparency on price and quality in healthcare; prevention and wellness; the promotion of electronic health records; and long-overdue medical liability reform. I see no reason — outside of partisan gamesmanship — why these commonsense provisions couldn’t be included in healthcare reform legislation this year.
Even on some controversial elements, there is more agreement than first meets the eye. From all ends of the political spectrum, you will be hard-pressed to find an economist that would defend the current tax treatment of healthcare. Jason Furman, President Obama’s deputy economic adviser, has written, “Replacing the current tax preference for insurance with an income-related, refundable tax credit has the potential to expand coverage and reduce inefficient spending at no net federal cost.”
Plain and simple, the current healthcare tax exclusion discriminates against millions of Americans and helps inflate the costs of healthcare. Those in the highest tax brackets and those with the most generous insurance plans receive the largest tax benefits. If you are self-employed, unemployed, or don’t get your coverage from your employer, the current tax code gives you nothing. I believe that we should equalize the tax treatment of health benefits and provide all Americans with the resources they need to purchase quality, affordable health insurance. The tax treatment of healthcare was poisoned with election year campaign politics and has been “taken off the table,” but it is a reform that we must revisit.
Of course, there are some more fundamental divides, as many in Washington believe that healthcare in America should revolve around the federal government — not patients and their doctors. It takes an uncomfortable faith in Washington to believe that spending can be restrained and bureaucratic waste can be contained if only we gave government more control.
Despite skyrocketing costs remaining our top concern, the majority has concluded that we are not spending enough on healthcare in America. We already spend over two-and-a-half times more on healthcare than any other country, with government alone spending roughly $1 trillion last year. Rather than add trillions more on top of that, as the majority is proposing, let’s take the money we already spend on healthcare, and spend it more efficiently, more effectively.
In the face of a looming entitlement crisis, the majority remains intent on creating a costly new government healthcare entitlement, believing that it can fairly compete with non-subsidized private plans. Here is how it works: The federal government “option” would reimburse doctors at below market prices in order to control costs, forcing those with private coverage to make up the difference. With costs continuing to mount, employers will increasingly find it more cost-effective to dump their employees onto the government-run plan and pay an additional 8 percent payroll tax for each worker. Some estimates state that under this public plan option, two out of every three Americans would lose their current coverage. The president has yet to explain this actuarial fact with his promise: “If you like what you got, you can keep it.”
With more Americans forced onto the government-run plan, the only way to contain costs will be through rationing by the federal government. The decision as to whether or not you need a potentially life-saving treatment will not be a decision you, your family or your doctor will make, it is a decision the government will make on your behalf.
The more Americans learn the details of what is being rushed through Congress, the more folks will be looking for alternatives. Thankfully, many in Congress have put forward innovative, patient-centered solutions. These alternative reforms demonstrate that we can achieve universal access to quality, affordable healthcare in America, without adding trillions in new taxes and debt, and without the federal government taking it over.
The consequences of getting reform wrong go beyond costly missteps to America’s economic, fiscal, and personal health: Washington-centered healthcare is an affront to the American ideal. Government-run healthcare threatens our historic reliance on personal responsibility and initiative, to be replaced by passivity and dependence on a full-blown welfare state. There is room for common ground on commonsense reforms — to not only promote fiscally responsible, patient-centered healthcare, but also to preserve the identity of an America rooted in free enterprise, limited government and individual liberty.
Ryan is ranking member of the House Budget Committee, senior member of the House Ways and Means Committee, and co-author of H.R. 2520, The Patients’ Choice Act.