MATTHEWS: Reforming health care the right way

ANALYSIS/OPINION:

Conservatives who work in health care policy quip that Republicans don’t have the health care gene. They don’t understand all the intricacies of the health care system and never saw much reason to learn about them because most of their constituents have medical coverage and are happy with it.

But as the reform debate makes clear, Democrats understand even less about how the health care system works, though that’s little deterrent because they want the government controlling it anyway.

About the only time Republicans have tried to address systemic health care policy issues - like dealing with the number of uninsured and the cost of coverage - was when the Democrats’ push for legislation made it impossible for Republicans to avoid it. Republicans usually cobbled together some “Democratic-lite” version of the legislation and then claimed victory when it passed.

That happened with the 1996 Health Insurance Portability and Accountability Act, which created privacy laws and imposed a number of new restrictions on health insurance, and the 1997 State Children’s Health Insurance Program, which created a health insurance entitlement for millions of uninsured children whose parents have low incomes but make too much to be eligible for Medicaid.

There is some reason to be encouraged as Republicans are finally recognizing just how important health care is in relation to personal freedom and the economy.

For one thing, polls show most Americans like the coverage they have. They don’t want government forcing them to give up that coverage or their choices.

Conservatives tend to focus more on tax and budget issues, thinking that’s what most Americans care about. But some 40 percent of Americans pay virtually no income tax. By contrast, the average family policy costs about $12,000 a year or more - paid for either directly by the individual or indirectly in the form of lower employee wages. And that doesn’t count out-of-pocket expenses.

That means that perhaps half the population spends more on health care and health insurance than on income taxes.

When put into that perspective, it makes a lot of sense that Americans would care about their health insurance. It’s one of the biggest spending items most of us have in any given year, probably second only to our house payments. And, like taxes, Americans don’t want to pay more for coverage, as they would under the Democratic plans being pursued.

Given Republicans’ newly found awareness of the importance of health care issues, we may see them begin to embrace the market principles that conservatives (along with some Republicans) have been touting for years. What are some of those principles?

Tax fairness: People with employer-provided health insurance get a tax break for the money spent on coverage, while many of those without employer coverage don’t. There is a very strong conservative consensus that we need to level that playing field, which, if done correctly, also could help low-income families pay for coverage.

Cross-state purchase of health insurance: We could increase competition and choice by allowing people in one state to buy a health insurance policy that is approved and available in another state.

Transparency: Consumers can easily find information about prices and quality in almost every sector of the economy - except for health care. The growing popularity of insurance policies that encourage consumers to be value-conscious shoppers in the health care marketplace will force more pricing and quality information.

Limited safety nets: For people who can’t get health insurance because of pre-existing medical conditions, 35 states have created high-risk pools to provide them with coverage. While some could work better, the principle here is to let the market work for the vast majority of Americans and provide a safety net for those who can’t access the system.

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