Reforms Conservatives Can Favor

As healthcare passions rise, let's keep in mind there are reforms that Republicans and conservatives can and should support.

As healthcare passions rise, let's keep in mind reforms that Republicans and conservatives can and should support. Here's my (non-exhaustive) list: * We should favor national health insurance exchanges to permit the self-employed to buy insurance with untaxed dollars, just as employees do through their employers. * We should favor the creation of non-government health cooperatives - provided that they truly are non-government, i.e. no government subsidies and no government guarantees. More Blue Crosses, yes; a healthcare Fannie Mae, no. * We should favor the creation of government bodies to compare the effectiveness of different healthcare practices. It really is true that some doctors and hospitals spend radically more than others without getting better results. The government has supported such research in the area of agriculture since 1914 without plunging the US into death-dealing totalitarianism. * We should respond to proposed new federal insurance regulations on a case-by-case basis.

For example: We should oppose federally required community rating (although of course insurers should be free to adopt community rating themselves if they wish). Community rating destructively forbids insurers to offer incentives for healthier behaviors, and it can price younger workers out of the insurance market.

On the other hand: The practice of imposing a "lifetime cap" on health coverage is outrageous and should be banned. The idea that a cancer patient might be told by an insurer: Sorry, we've reached our limit, the rest of the cost falls on you, violates the very purpose of insurance and exposes Americans to intolerable risk and fear.

* We should work where we can to move away from employer-provided care to individually purchased care that can follow the insured person from job to job. Extending the length of COBRA benefits could be a good way to start, but the health care exchanges are likely to be the ultimate answer. * We should demand tort reform and medical malpractice reform. As the Senate Finance committee's white paper notes:

Medical malpractice insurance premiums have risen steadily over recent decades, at times increasing an average of 15 percent a year. Some states have seen even more dramatic increases. Pennsylvania, for example, experienced increases ranging from 26 to 73 percent in 2003.

*  We should endorse the Obama administration's plans to shift Medicare away from fee-for-service medicine to payment-by-the-case and to seek other money-saving reforms within Medicare. * We should of course fight against any so-called public option. Direct government provision ought to be the conservative red-line; No deal at all is preferable to a deal that includes a bigger government entry into the insurance business.