Conservatives Need to Reach Outside Their Comfort Zones on Healthcare Reform
As a matter of practical politics, it would be better to find ways to reform healthcare that are market oriented, economically sensible, respectful of individual freedom and limits on government, and capable of winning broad public support. This is a difficult challenge, and it will require conservatives to reach outside their comfort zones.
Patient-centered care is a popular concept in the field of healthcare reform. It is defined as “healthcare that is respectful of patients’ preferences, needs and values and that reflects an understanding that the patient is an active partner in decisions about his or her own health.”
Person-centered care requires doctors to form trusted, personal relationships with their patients, with empathy and two-way communication. It also means that they see beyond the patient’s physical well-being and look at emotional, social, mental, and financial aspects of a patient’s situation.
However, there are important distinctions between a person-centered care approach and consumer orientations calling on patients to be prudent purchasers of medical services. One key difference is that the former empowers patients, while the latter expects patients to solve society’s cost-containment problems.
To address the hopes and dreams of the American people, a serious health-reform agenda must offer solutions that are truly market oriented, economically sensible, respectful of individual freedom, and respectful of limits on government power. That will take more than a superficial bromide of price transparency for a small subset of services and procedures that account for a tiny fraction of overall health-care spending.
It will also require an appreciation of the fact that a significant percentage of insured workers are relatively risk-averse to being pushed out of familiar employer coverage into unfamiliar, privately offered insurance arrangements. Conservatives who push too hard for a quick and complete shift away from the tax exemption of employer-sponsored coverage will risk undermining the relative stability that most Americans enjoy in their health coverage until effective alternatives become available.
Republicans are aiming to make health care more decentralized by shifting some of the funding burden to the states. They want to reduce the amount of federal funds to Medicaid and give states the freedom to redefine the essential services insurance must cover and experiment with high risk pools. This could strain state resources, undermine labor mobility and weaken key macroeconomic stabilization mechanisms.
Decentralisation has been promoted as a strategy for improving governance in states emerging from conflict and during transitions to democracy as part of peacebuilding efforts and during periods of state-building. However, it is important to understand the conditions under which this may improve quality and access to healthcare. A decentralized approach must be carefully balanced with a centralized system that ensures coordination and accountability.
The conservative worldview rests on a rejection of coercion and an embrace of individual autonomy. This principle applies to the right’s cherished views of free choice and head-to-head competition among businesses.
Yet federal tax policy and government health entitlement programs radically distort the private insurance market. As a result, health-insurance costs are galloping out of control, eating up an ever-larger portion of Americans’ incomes and pushing many out of coverage.
Consequently, serious reforms must seek to redress these distortions. Achieving this will require conservatives to better engage with delivery-system issues. For example, achieving genuine consumer choice will require that people get information about the performance of their health-care providers, rather than settle for superficial bromidies like price transparency. And it will require that insurers be required to offer a complete menu of coverage options, not just a bare minimum.
Conservatives may decry the ACA’s expansion of government power and spending at a time when deficit reduction should be a priority. But they still lack a package of practical reforms to replace it.
The most promising options include medical savings accounts, which allow affluent people to set aside income tax-free for future health expenses; large pooled catastrophe medical insurance, in which the healthy subsidize the unhealthy; and defined contribution financing of health coverage choices coupled with more targeted need-based subsidies. A combination of these ideas might satisfy conservatives’ desire to move American health care further to the right, while enabling them to keep employer-sponsored insurance as an alternative. This would enable them to retain the countervailing political power and institutional shield that it currently provides against forces pushing various forms of national healthcare, socialized medicine, and more government control over coverage and care.