The Supreme Court and the Affordable Care Act: A conservative’s response

    Republicans are outraged by Thursday’s Supreme Court decision — at least in public. But behind the scenes, I suspect Mitt Romney and his staff are grinning ear to ear. 

    Republicans are outraged by Thursday’s Supreme Court decision — at least in public. But behind the scenes, I suspect Mitt Romney and his staff are grinning ear to ear. From now until November, the Republicans will shout “Vote for us and we’ll repeal Obamacare!” They’ll paint both Obama and the Supreme Court as wrong-headed and the Affordable Care Act as leading us inevitably to socialism.

    The sad part is that both the so-called Affordable Care Act and the Republican response of “repeal it now” are misguided answers to the wrong question: “How do we pay for our health care?” Neither offers a good answer to the critical second question: “Why does health care cost so much?”

    There is an answer to this second question, but the Democrats hate it, and the Republicans are too timid to propose it. That solution, of course, is to unleash the power of the market. And, before you stop reading in disgust or send me hate emails, let me define what I mean by “the market.”

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    Start with what it’s not. The market is not insurance or pharmaceutical companies or any other big health care providers (although they all play a part). Instead, “the market” is simply you and me out shopping for our own health care in the same way we shop for a new car or a dining room set or a flat-screen TV. Give us the opportunity, and we will drive down health care costs just like we’ve done with all of these consumer items.

    There are two common arguments against this unleash-the-market proposal. The first is that healthcare is too complex for most people to manage by themselves. But once we recognize that our health care providers are our consultants, shopping for our own health care changes from a medical challenge into a management challenge that most people can handle just fine.

    The second argument against the unleash-the-market proposal is that nobody has enough money to pay for their own health care. But the combination of a high-deductible health insurance policy with a health savings account (HSA) solves this problem reasonably well. The insurance policy protects against unexpected, catastrophic and chronic health care situations. The individual pays for everything else using the HSA, which is funded, in part, by the reduced cost of the high-deductible insurance plan.

    Government has a part to play here. Employers now enjoy a tax incentive for providing health insurance. That should be changed to encourage them to offer high-deductible plans and to fund employee HSAs with the savings. In addition, Medicare and Medicaid should be slowly changed to government-paid, high-deductible insurance coupled with HSAs.

    So, as a conservative, I am disappointed not so much by Thursday’s Supreme Court decision, but by the whole health care debate. The bottom line is that we’ll never solve our health care problems until we focus on the right question and unleash the market to provide an answer.

    Chris Foreman is a business consultant in Swarthmore, Pa.

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