The Politico - A Prescription for Transforming Health Care
By Rep. Paul Ryan
When Congress takes up the children's health insurance bill this week, the debate will reflect the much broader discussion of health care reform in general. This larger issue certainly deserves the attention it's getting: Health care consumes about one-seventh of our economy and is vitally important to Americans' standard of living.
The most frequently cited challenges in health care are, of course, cost and coverage: Health care costs are rising too fast, and nearly 50 million people have no health insurance at all. Unfortunately, many of the proposed reforms try to address these legitimate concerns in an incremental and piecemeal fashion. Many reforms also contain or lead in the direction of a standard mix of impersonal regulations, mandates and centralized control that will only add more layers of burdensome complexity.
What's needed is a fresh vision a 21st-century approach that transforms health care itself in a way that builds on our nation's most fundamental strengths. Here are some of the criteria that should apply:
· Reform must be comprehensive. Health care is not a separate and discrete part of our economy. It is a dynamic network of participants in both the private and public sectors, who are constantly interacting and readjusting to one another. Further complicating this arrangement are the federal tax code, the government's large and costly health programs Medicare and Medicaid and the lack of transparency in the cost of medical services, to name just a few. Because the components of health care range so widely, addressing the problems in only one or two areas while leaving the others unchanged will yield only limited and temporary benefits. We must look to the broad landscape to ensure that health care reform will be truly beneficial and lasting.
· It should be built on the principle of individual ownership. Comprehensiveness, however, does not necessarily require greater complexity. In fact, the most profound benefits are likely to come from the broad application of well-known, long-standing principles.
One of these is ownership. Individual ownership has long been a central component of America's prosperity. Yet this principle still does not apply in health care, one of our most valued resources. One reason is the federal tax code, which creates a bias in favor of third-party payers of health insurance and against individual purchasers. As a result, health insurance is owned by employers or the government, and this means patients don't really control their own health care choices. Health insurance should be owned by the individuals who use it. This would restore the most important relationship in health care between the patient and the doctor and would also encourage insurers to develop a greater variety of coverage options, making the health insurance market itself more effective and more efficient.
· It must provide health care security. Clearly, any reform plan must provide a sustainable safety net for low-income people or those with health problems that put affordable coverage out of their reach. A number of state governments have established "high-risk" insurance pools for such individuals proving once again that state governments often are more responsive to their specific populations. We should encourage more of this state-based creativity, and at the same time arm individuals with the resources to buy across state lines if necessary.
· It must promote our international competitiveness. These things must be achieved without vastly expanding government spending and taxes. These burdens are the greatest threat to our nation's ability to compete and lead in the international economy; a failure of economic competitiveness will jeopardize our ability to provide ever-improving health care services and make them available to everyone. This is another reason why reform in the health care market must be with reforms of government health programs.
The problems in health care are complex and demanding but they are not impossible. What's needed is a comprehensive, forward-looking approach that builds on our creativity, our economic strengths and our compassion. Above all, it should transform health care to respond to the most important contributor toward America's prosperity: the individual American.