Health Care

What Should the GOP Propose on Healthcare? A Reply to Bobby Jindahl | Niskanen Center

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Writing this week in the Wall Street Journal, Bobby Jindal asks what the GOP should propose on healthcare, in order not to be “caught flat-footed next time they are in charge.” And by the way, why wait until the GOP is in charge again? Going by what Jindal says, there are ample grounds for at least incremental bipartisan reforms beginning as soon as the Biden team takes over the White House. 

Jindal asks good questions and suggests some promising answers. Here is what I think he gets right.

Do conservatives continue fighting for a full repeal of Obamacare spending and taxes, or do they accept current spending as the baseline? 

Jindal notes, correctly, that it is easier politically to spend money differently than to spend less. I agree. I have long held the view that the baseline question for healthcare reformers should not be how much we should spend, but rather, what improvements we could buy for the money that is already in the federal budget. My own answer is that we could do a lot better with no new spending or taxes. Jindal suggests several market-friendly ways to redeploy money in ways that would move toward the kind of system I have advocated.

One would be to place more emphasis on protecting families from the financially catastrophic expenses of chronic conditions and catastrophic illnesses or accidents. Jindal mentions high risk pools. A similar but better mechanism would be a comprehensive system of reinsurance to cover the most expensive cases. Such a reinsurance system is a key part of the Fair Care Act, the only serious GOP healthcare proposal now on the table. It isn’t perfect, but I can’t understand why Republicans don’t take that ball and run with it. 

Jindal also suggests reforming the tax preferences that prop up our system of employer-sponsored insurance (ESI). Good idea. I have long maintained that ESI is the original sin of the U.S. healthcare system. ESI reform is an element both of the Republican Fair Care Act and Biden’s centrist healthcare proposals. As such, it offers an excellent opening for bipartisan action, which brings us to Jindal’s next question.

Do conservatives fight for aspirational goals or negotiate for incremental gains?

Jindal does not give a yes-or-no answer, but clearly, he leans toward a “Yes.” Among the areas where he thinks the GOP could find common ground with a Biden administration, in addition to ESI reform: “Expand the use of value-based purchasing in government programs to reduce costs and improve health outcomes, reduce the burden of pharmaceutical research and development costs paid by American patients, expand the use of telehealth, end surprise billing, promote price and quality transparency, and make it easier for patients to access and protect their health data.”

Go for it.

Do conservatives care more about cost saving or coverage?

Jindal faults Obamacare as “more successful at shifting costs to taxpayers than reducing costs.” Yet he acknowledges that Democrats have won elections by defending a program that guarantees coverage for pre-existing conditions, while the GOP is able to offer nothing specific. So, what better area for bipartisanship than a push by Republicans to include robust cost-reduction strategies in any reform bill in exchange for backing Democratic protections for pre-existing conditions? 

A recent CBO report on policies to achieve near-universal health insurance coverage lays out six pathways to meaningful healthcare reform. Several of them leave ample room for key GOP objectives, such as preservation of a role for private health insurance and cost-reduction through market-friendly measures to increase competition and innovation. Surely, given just a smidgen of good will, the parties can find at least something to agree on in the new year.

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