There is No 'Conservative Case for Obamacare'

By Nina Owcharenko

Sometimes, messaging eclipses policy. Exhibit A: J.D. Kleinke’s New York Times opinion piece – which offers a purely superficial case for why conservatives should support Obamacare.

Kleinke’s column – like Obamacare itself – tries to cover up a liberal policy agenda by hijacking conservative principles and terminology. That proponents of the law must resort to such linguistic sleight of hand proves only that they recognize the American people are no fans of government-run health care.

Consider the term “health exchanges.” The Heritage Foundation and other conservatives use the term to describe a mechanism that allows individuals to purchase coverage of their choice without losing existing tax breaks. The architects of Obamacare appropriated the term and applied it to the monster of their own making: a government-run operation that will regulate insurance offerings like a public utility. That’s nothing close to the free-market exchange envisioned by conservatives, where insurance sellers and buyers can negotiate freely.

In an Obamacare exchange, insurers’ customer is the government, not the American consumer. So when Kleinke notes that insurers are “quietly supporting” the law, it should be no surprise. They are working to appease their customer – the government.

Kleinke goes on to argue that Obamacare will fix the dysfunctional markets. But actually Obamacare makes it all worse by piling on more regulations that actually discourage people from buying coverage. To overcome this self-defeating approach, the architects were forced to adopt the Obamacare individual mandate. How else would the government get people to buy coverage? Of course, here again, the left hijacks a conservative term “individual responsibility.” But forcing people into a dysfunctional government-controlled market by threatening them with a tax penalty is not individual responsibility.  It’s government coercion.

It’s also worth noting that Heritage has moved away from its support for an individual mandate—even in a competitive system. Over the years, our research has found the best way to expand coverage and to fix the dysfunctional market is by putting patients in control. Here again Kleinke gets it wrong.

Kleinke points out that health care providers are accountable to the wrong people. But that’s because they are accountable to the people paying their bills – employers and governments – rather than patients. Obamacare would do nothing to put patients first. Instead, it puts government in charge. The only way to make the health care sector accountable is to make the insurers and providers directly responsive to the patient, not the government.

Rather than shift power into the hands of the people, Obamacare shifts power to federal bureaucrats. Government decides what benefits health plans can and must offer, how doctors and providers should deliver care, and, ultimately, what health care and services will be available in our country.

The poster child for this bureaucratic power grab? The Independent Payment Advisory Board (IPAB). Created by Obamacare, this unelected and unaccountable board will use its weight to inject more government price controls, squashing any real competition or innovation in Medicare. Some liberal think tanks have even suggested expanding IPAB’s authority over all health care providers and sectors.  

In a truly consumer, market-based system, the health care sector (insurers, doctors, hospitals, and other providers) are accountable to the patients and are able to adapt as consumers demand, not as government mandates.

Ironically, Kleinke’s defense of Obamacare mandating full coverage for women’s reproductive health exposes Obamacare for what it really is – government-run health care. Under Obamacare, the government deems what is acceptable and appropriate. This underscores who is really in charge. It’s the government, not the woman or her doctor.  

New York Times readers wanting to understand what conservative health care reform looks like should peruse the Heritage Foundation’s Saving the American Dream plan. They certainly won’t get it from Kleinke’s column.

Expecting conservative ideas to bloom from Obamacare is wishful thinking. That’s why the Heritage plan starts with repeal of Obamacare. From there, it recommends fixing health care entitlements by embracing choice and competition, not price controls; equalizing the tax treatment of health insurance so people aren’t discouraged from buying coverage on their own; and allowing for true portability by making sure the market rules protect those who buy their own health insurance.  

As with all policy matters, what matters are the details—not the buzzwords, which can be appropriated and slapped onto concepts. So if you still believe there is a conservative case for Obamacare, I’ve got a bridge to sell you.

Nina Owcharenko is director of the Heritage Foundation’s Center for Health Policy Studies.

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