Avik Roy is a graduate of Yale Medical School who has published extensively on the problems of America’s current health system and Health Care Reform.
Republican and conservative leaders failed the cause of free-market health reform in three principal ways. First, they failed to make a moral case for replacing Obamacare, as opposed to purely repealing it. As a result, they then failed to unite the hard-line and pragmatic wings of the GOP around a coherent health-care-reform proposal. And due to the ambitions of the 100-day legislative agenda, and the peculiar legislative calendar associated with the Senateâ€™s reconciliation process, they chose not to invest the time in getting health-care reform right.
Conservatives intuitively understand the moral case for repealing Obamacare. The law significantly expands the role and scope of the federal government in determining Americansâ€™ personal health-care choices. Its individual mandate is a constitutional injury. And its Rube Goldberg-like maze of insurance regulations has made health insurance unaffordable for millions.
But when it came to replacing Obamacare, Republicans usually presented the case in exclusively political terms: Replacement was necessary because the alternative would be daily front-page stories of the millions thrown off of their health-care plans by the GOP Congress. Conservatives rarely attempted to make a moral case for replacing Obamacare. Indeed, if you believe that the federal government has no legitimate role in helping the uninsured afford health coverage, your intuition is that there isnâ€™t a moral case for replacing Obamacare. …
That intuition is understandable, but mistaken, because it is in fact the federal government that has made health insurance so costly through seven decades of unwise policies. Those policies include the exclusion from taxation of employer-sponsored health insurance, an outgrowth of World War II-era wage controls. They include the enactment of the Great Society entitlements, Medicare and Medicaid, in 1965. They include the EMTALA law, signed by President Reagan, that guaranteed free emergency-room coverage to everyone, including the uninsured and illegal immigrants. And they include Obamacare.
This seven-decade pileup of federal intervention in the health-care system is directly â€” and exclusively â€” responsible for the astronomical costs of the present-day American health-care system. It is not right, when confronted with such a state of affairs, to shrug our shoulders and say â€œtough luckâ€ to those who canâ€™t afford insurance. Indeed, we have an affirmative duty to reform federal policies so as to make health insurance once again affordable for the working poor.
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