By Paul Ryan
There is no debate in Washington more critical, more consequential, and more controversial than the current debate over health care reform. Unfortunately, Washington is missing an opportunity to truly engage the American people in the debate they deserve – keeping details under wraps, making decisions behind closed doors, and rushing legislation through Congress without regard to legitimate concerns and alternative solutions.
As three House committees are set to markup health care legislation this week, finding common ground would mark a positive step forward in tackling the long overdue need for health care reform. Unfortunately, the Majority’s track record in the 111th Congress does not provide us with much hope.
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 health care 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 health care; 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 common sense provisions couldn’t be included in health care 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 health care. Jason Furman, President Obama’s deputy economic advisor, 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 health care tax exclusion discriminates against millions of Americans and helps inflate the costs of health care. 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 health care 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 health care 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 sky-rocketing costs remaining our top concern, the Majority has concluded that we are not spending enough on health care in America. We already spend over two-and-a-half times more on health care 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 health care, 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 health care 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% 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 reconcile 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 health care 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 health care is an affront to the American ideal. Government-run health care 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 common sense reforms – to not only promote fiscally-responsible, patient-centered health care, but also to preserve the identity of an America rooted in free enterprise, limited government and individual liberty.
Congressman Paul Ryan serves Wisconsin’s 1st Congressional District. To contact him by phone in Washington, D.C., call (202) 225-3031. Or visit Paul Ryan at www.house.gov/ryan