Let’s start with a pretty simple premise: the system that existed prior to the Affordable Care Act (Obamacare) was not — repeat not — a free market system.
This is an important concept to grasp, because there is an increasingly prevalent notion among conservatives that “we need to repeal Obamacare so the free market can do its job again.” Boy is it wrong.
More on that in a moment.
For six years now, Bruce Poliquin has been a loud and frequent critic of the ACA, which makes his vote on Tuesday against repealing it curious to many.
As he ran for office this past fall, he made clear that he opposes the president’s health care initiative. On his campaign website, Poliquin went into great detail about his priorities on health care.
In it, he said as far back as last winter, “In Congress, I’ll fight […] to end the expensive, intrusive, and unfair government take-over of our health care. I’ll work tirelessly for a free market solution to help our 2nd District families buy affordable health insurance[.]”
You’ll notice the absence of “I will vote for a straight repeal of the ACA.” It was never on there through the whole campaign, and there is a reason why.
The process of implementing the ACA has taken five years now. It has cost corporations, insurers, and consumers hundreds of millions of dollars collectively, to comply with the new law.
At the same time, roughly 63,000 Mainers have signed up for the Obamacare exchange plans. People are getting subsidies. People have chosen plans, spent money, and gotten themselves and their families coverage.
Reverting the law to its previous, non-Obamacare state would not be as simple as switching off a light switch. It would compound the regulatory and compliance costs for businesses and require them to jump through all of these hoops again, costing millions.
On top of that, it would negatively impact tens of thousands of Mainers — and millions of Americans — who have been purchasing plans on the exchange. Whatever you believe about the quality and cost of the exchange plans, they exist, and some people are buying them. To destroy the system without a transition plan would do exactly what we as conservative critics just attacked the president for doing: canceling health care plans and harming patients and consumers.
Obamacare was designed to create this very problem. It is so complex that if you simply repealed the law, everything wouldn’t simply “go back to the way it was before.” It is the knot in a necklace that you simply can’t untie without great effort.
In any event, this bill will be vetoed by the president immediately, and Republicans do not have enough votes — two-thirds in each chamber — to override the veto. So this is the very definition of a symbolic vote, only taken so those voting yes can say they voted to repeal Obamacare.
Repealing with no further reform was a solution years ago. It, unfortunately, isn’t a realistic one today. And the Republicans in Congress know that.
But even if the vote wasn’t symbolic, returning to the old system would not give you a free market. A truly free market requires freedom to buy and sell. In health care, it requires price transparency, the ability to tailor plans to different groups, ease of purchase, open price competition, control by the consumer, and a lack of price and service manipulation by the government.
If Obamacare is to be deconstructed, it has to be accompanied by a comprehensive reform to the system, to allow it to function as a truly competitive market.
I would suggest destroying the employer-based health care system, making health insurance plans portable so they can follow an individual, introducing price transparency, repealing coverage mandates to insurers, allowing them to tailor their own plans to consumers, and coming up with a simple credit or subsidy system to deal with coverage for the poor.
Poliquin said that he will support the repeal of Obamacare, but he wanted to have a free market alternative there to replace it. What I just proposed is a start.
My suggestion to Poliquin is this: if he is truly serious about reform, then it is time for him to step up. The Republicans in Congress have had six grueling years to develop their alternatives to Obamacare, and they weren’t able to offer anything attached to this repeal vote. They are clearly not going to do anything meaningful on this subject.
This gives him a chance to demonstrate his value. Do what they can’t do. Offer that alternative. Sponsor a bill with an Obamacare repeal, and propose that free market alternative.
After all, this is Maine. Our motto, Dirigo, is “I lead.” So do what they have all failed to do on this issue. Lead.