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The public policy blog of the American Enterprise Institute
When it comes to health care, the Left is right.
Of course, so is the Right.
The Left wants health care reform that focuses on three issues: making health care affordable, high quality, and universal. The Right wants reform that focuses on two separate issues: making health care provision efficient and ensuring that health policy acknowledges the diversity of patient preferences. These sets of values are both important. In that sense, both sides are right.
Unfortunately, these goals have been presented as mutually exclusive. The health care narrative has been, for years, either efficiency and personal choice or universality, affordability, and quality. We can have, we’ve been told, either progressive health care reform or conservative.
This is a false choice.
We do not have to pick either the Left’s or the Right’s goals. Indeed, meaningful health care reform should incorporate the goals of both. AEI’s National Research Initiative sponsored a research project by leading health scholars from across the country to design a reform proposal that would do just that.
The result of their research, the Best of Both Worlds proposal, proposes establishing government financed premium supports to subsidize the cost of health insurance, eliminating incentives for employer-provided health insurance, allowing individualized premiums, and promoting long-term contracts. This proposal is unique and critically important to any serious health care reform discussion for several reasons.
First, it demonstrates that the dichotomy between the Left’s values and the Right’s is a false one. It shows, with a set of concrete policy prescriptions, how to create a system that would better achieve both conservative and progressive goals than either the pre-ACA system or the ACA. Even more importantly, the proposal demonstrates that aiming to achieve the goals of both sides may be more effective at accomplishing each side’s goals than focusing on one side’s or the other’s.
Second, BoBW gives the Right a new way to realize their values through fresh, forward-looking policy prescriptions. At present, the Right’s position is set in opposition to the ACA. However, current methods of resistance are ineffectual at combating the ACA, and conservatives need to change their position if they want to be successful. The BoBW proposal is a concrete set of policy prescriptions that the Right can offer as a policy alternative. This is an opportunity for conservatives to expand on their unity against the ACA to include an alternative plan that accomplishes universal coverage, is cheaper, promotes individual choice, and protects the poor.
Third, BoBW forces the Left to reconsider their commitment to the ACA. If they are seriously committed to universal coverage, affordability, and quality care, then they should be committed to policies that will best accomplish those goals. BoBW will accomplish universal coverage more effectively than the ACA. Every American but the rich will be significantly better off financially under BoBW. The poor will be lifted out of Medicaid and into the mainstream private insurance market, with higher access and better quality care. Simply put, BoBW could accomplish the goals of the Left more effectively than the ACA.
This proposal moves the health care reform debate forward. Instead of arguing about whether we want efficiency or affordability, choice or universal coverage, we can accept that both sets of goals are important. The real question now is not which set of values we want to achieve — we know we can have both. Now, we have to consider the relative merits of each value and how we want to weight them and support them in policy.
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