Back in March 2010, I set down some thoughts about what a conservative fix of the Affordable Care Act might look like. Those thoughts seem even more timely today, now that it's clear to all that the ACA is here to say.
1) One of the worst things about the Democrats' plan is the method of financing: an increase in tax on high-income earners. At first that tax bites only a very small number, but the new taxes will surely be applied to larger and larger portions of the American population over time.
Republicans champion lower taxes and faster economic growth. We need to start thinking now about how to get rid of these new taxes on work, saving and investment -- if necessary by finding other sources of revenue, including carbon taxes.
2) We should quit defending employment-based health care. The leading Republican spokesman in the House on these issues, Rep.Paul Ryan, repeatedly complained during floor debate that the Obama plan would "dump" people out of employer-provided care into the exchanges. He said that as if it were a bad thing.
Yet free-market economists from Milton Friedman onward have identified employer-provided care as the original sin of American health care. Employers choose different policies for employees than those employees would choose for themselves. The cost is concealed.
Wages are depressed without employees understanding why. The day when every employee in America gets his or her insurancethrough an exchange will be a good day for market economics. It's true that the exchanges are subsidized. So is employer-provided care, to the tune of almost $200 billion a year.
3) We should call for reducing regulation of the policies sold inside the health care exchanges. The Democrats' plans require every policy sold within the exchanges to meet certain strict conditions.
American workers will lose the option of buying more basic but cheaper plans. It will be as if the only cable packages available were those that include all the premium channels. No bargains in that case. Republicans should press for more scope for insurers to cut prices if they think they can offer an attractive product that way.
4) The Democratic plan requires businesses with payrolls more than $500,000 to buy health insurance for their workers or face fines of $2,000 per worker. Could there be a worse time to heap this new mandate on smaller employers? Health insurance comes out of employee wages, plain and simple. Employers who do not offer health insurance must compete for labor against those who do -- and presumably pay equivalent wages for equivalent work.
Uninsured employees have now through the exchanges been provided an easy and even subsidized way to buy their own coverage. There is no justification for the small-business fine: Republicans should press for repeal.