David Frum

04.03.13

One Social Conservative's Alternative to Obamacare

Social conservative Bob Patterson reasons his way to an unlikely conclusion: the best replacement for Obamacare would be … something rather like Britain's National Health Service.

First, congressionally charter Blue Cross-Blue Shield as a monopoly to provide basic coverage to all Americans, except retirees. And grant the regulated nonprofit authority to impose payer-fee schedules on providers of routine care and services, much as Medicare does. A utility-style Blue Cross-Blue Shield covering all working-age Americans and their dependents would offer enormous administrative economies of scale and an insurance pool of unprecedented size. By trumping state regulations, the plan would be relieved from paying for luxuries like aromatherapy, Viagra, sex-change operations, hair implants, birth control, or elective abortion. Nothing would preclude other carriers from selling supplemental insurance for medical non-necessities, purchased by individuals at after-tax rates.

Jointly funded by a modest payroll tax and shale-oil severance fees, this utility would not only replace all nonsupplemental health-care plans, but also Obamacare, state exchanges, much of Medicaid, and the State Children's Health Insurance Plan. Medicare - and Medicaid for the severely disabled - would remain in place.