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Paul Ryan: If I Were in Charge of Health Care

There is no debate in Washington more critical, more consequential and more controversial than the current debate over health care reform. With Congress out of session for the month of August, the weeks ahead represent a unique opportunity for an honest and open debate here in Wisconsin - and across the nation - on how best to tackle the long overdue need for health care reform.

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; and 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 when Congress reconvenes in September.

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 Barack 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."

 We need tax equity

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 skyrocketing 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.

No government rationing

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-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 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. My reform proposal - H.R. 2520, The Patients' Choice Act ( - demonstrates 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.

Health care reform is one of the most crucial domestic issues this Congress will act on and requires the input of all Americans. With an engaged and educated public actively involved in the health care debate, I believe that your elected representatives can start anew and embrace this historic opportunity for reform. Congress can - and must - rise to meet the challenge before us, but we can't do it without you.

 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

Comments (2)
  • Robert  - Government Health Care

    Mr. Ryan,
    I share your thoughts and actions. I hear many debates centered around health care like "Americans deserve health care" but little is said about non-Americans. Illegals have had access to free health care in many states and the burdon has taken its toll. Many people come here illegally for work and free health care. How does any goernment option address this issue?

    During the 80's and 90's we had HMO's a popular choice for employers because of its cost. There is much evidence to support that this system put many people prematurlly into the grave because of the profit driven primary care provider. Also there was no recoarse for malpractice because of the rules Congress put in place.This generated a system to support less than average DR's. By the way some of the worst hospitals in this country are Government run and there call VA Hospitals.

    If the Federal Government EVER did anything great, than I could see nationalizing it. But we have every example that the Government is a poor manager of Health Care ie. Fraud and waste in Medicare, failed HMO system of the past, VA hospitals.

    Mr. Ryan, lets let the Federal Government get Medicare and the VA system running as an example of National health Care, then maybe, maybe we can look to expand coverage.

    Marine Corps Vet

  • Mr. Nobody  -

    Thanks for sharing!Your articles it is wonderful!!

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