Blue Collar Conservatives: Recommitting to an America That Works (14 page)

            
1.
   
Provide at least one avenue for those with preexisting conditions to obtain insurance coverage at no more than 125 percent of the average price for individual health insurance in the state;

            
2.
   
Include in the coverage plan for this population a meaningful education and care management component; and

            
3.
   
Create a continuous-improvement program to monitor results and cost, ensuring that patients are getting the healthcare they need and taxpayers are investing in something that works.

Once we have addressed those with preexisting conditions, we must unleash the power of competition and free markets to create more choices and lower costs for traditional insurance
consumers. Enhanced competition in both the number of carriers in the market and in the types of products available will drive innovation and help control costs.

In exchange for the federal funds in the block-grant program, I would ask states to take two other important steps to provide citizens and small businesses a greater number of choices:

            
1.
   
Allow carriers to offer at least one policy that is free from expensive coverage mandates. This will allow people, not the government, to balance coverage and cost, and to shop for products that meet their individual needs at prices they can afford; and

            
2.
   
Adopt a uniform licensing process for out-of-state insurance companies to make it easier to sell insurance across state lines, while preserving the important consumer protection role of state government.

States are already taking the lead in creating innovative programs designed to improve the health of their citizens. In Iowa, where I have spent so much time, Governor Terry Branstad launched the “Healthiest State Initiative” in August 2011. He has a five-year goal of moving his state from nineteenth to first in the Gallup-Healthways Well-Being Index, which measures physical,
mental, and emotional wellness. The program engages individuals, families, businesses, faith-based organizations, not-for-profits, and the public sector in a community-focused effort to educate citizens on healthy habits and to change behavior. The results are telling. By the 2012 report, Iowa had climbed ten spots to number nine, and I suspect they will climb even farther when the 2013 numbers are released.
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South Carolina had the fourth-highest percentage of premature babies in the nation in 2011, and one in every ten babies was admitted to a neonatal intensive care unit (NICU). Tony Keck, the state’s director of health and human services, decided to tackle this problem head on. In July 2011, he created the “Birth Outcome Initiative” in collaboration with Blue Cross Blue Shield of South Carolina, the South Carolina Hospital Association, the March of Dimes, and others. The group developed several approaches, including payment reform, to improve the quality of care to moms and babies. By the first quarter of 2013, the program had already reduced NICU admissions and documented $6 million in savings for Medicaid.
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The federal government needs to encourage and support more of this state-level innovation rather than creating roadblocks to it and dictating one approach for everyone.

The federal tax code is an obstacle to sound healthcare reform, discriminating against citizens who buy their own medical insurance instead of getting it through an employer.
When I served in the Senate, I proposed a major reform that would have ended this discrimination by allowing individuals to buy insurance with pretax dollars just as companies do for their employees. I’m proud that this idea has become a key feature of the plan to replace Obamacare introduced by my old colleagues Senators Tom Coburn, Orrin Hatch, and Richard Burr. You’d think this would be a no-brainer—especially for the Democrats, who pride themselves on being the champions of the “little guy” against the corporations. How can they defend allowing corporations and other employers to buy insurance tax-free for their employees but not individuals?

This unequal tax treatment is at the root of the pre-Obamacare problems in our healthcare system that the president keeps referring to. Beginning in 1942, when President Franklin Roosevelt excluded insurance benefits from his wartime freeze on wages, and accelerating in 1954, when Congress made those benefits tax-free, the nature of health insurance has changed. To take advantage of the anomaly in the tax code, employers began giving employees prepaid routine medical care through “insurance” policies that were no longer actually insurance in the classic sense. As many pundits have pointed out, if we had the same kind of “insurance” for our cars as we now have for our health, the insurance company would pay for all our gas—and we’d have very little incentive to be careful of how much we spent on it!

Whenever a third party (an insurance company or the government) is paying, costs are bound to skyrocket. Why does laser vision-correction surgery keep getting cheaper while other kinds of medical care get ever more expensive? Well, vision-correcting eye surgery typically isn’t covered by insurance. Patients pay for it themselves directly in the free market, and they demand better prices and service. In America today most people aren’t even paying directly for their insurance, let alone most of their actual care.

A true revolution in healthcare would not increase the role of government, as Obamacare does, but make healthcare more like the industries that continue to give us more innovation at cheaper prices. There are certain things the government simply can’t do as well as the private sector. The medical field requires a more dynamic solution that only private industry can provide.

Compare medicine with telecommunications, for example. Can you imagine if President Clinton had decided in the 1990s that everyone should have a cell phone? Since they were so expensive, he might have proposed that the government pay for everyone to have the phone that the Federal Communications Commission decided was best for him. Since the government would be guaranteeing everyone a cell phone and subsidizing it, the people who got BlackBerry devices and Motorolas would have to pay extra, and those companies would be taxed to support the program. In addition, the law
might give the government the power to tax expensive innovations that regulators thought unnecessary—like phones with cameras, music, videos, internet, or apps. Absurd, right?

That’s what Obamacare is doing to healthcare. Why, for example, have we imposed a punishing new tax on medical device manufacturers? These are the companies that make replacement hips and knees and devices used in heart surgery—the procedures that have allowed American seniors to live active lives rather than being confined to nursing homes and wheelchairs. You get less of what you tax. Why would we want less lifesaving medical innovation for the future? Whatever the problems of American healthcare before Obamacare, Americans have benefited for decades from the innovation of the medical device manufacturers. This is one American industry that we can still be proud of—and Obama wants to cripple it. The new tax is not even a tax on profits; it’s on all of a manufacturer’s revenue, even if that manufacturer’s business is running at a loss. In other words, a medical device manufacturer can be a startup developing new products and not yet making a penny of profit, and it still gets hit by the tax. As former Congressional Budget Office director Douglas Holtz-Eakin reports, this Obamacare tax is already hurting companies and eliminating jobs. In Michigan, for example, Stryker Instruments has laid off a thousand workers.
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And Cook Medical of Indiana is holding off on building five new plants it had planned.
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And that’s not the only way Obamacare is contributing to unemployment. It’s also hurting the economy as a whole. Obamacare will “destroy the foundation of the 40 hour work week that is the backbone of the American middle class,” according to a July 2013 letter from the presidents of the International Brotherhood of Teamsters and two other big unions. “Perverse incentives” in Obamacare that the union presidents pointed to include “an incentive for employers to keep employees’ work hours below 30 hours a week. Numerous employers have begun to cut workers’ hours to avoid this obligation, and many of them are doing so openly.”
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As Betsy McCaughey explains, the Labor Department actually reported “the shortest average work week on record” from January 1 to July 31 of 2013.
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That was when large employers were anticipating that the mandate to buy insurance for any employee working more than thirty hours a week would go into effect on January 1, 2014, as Congress wrote in the law.

In fact, the employer mandate never went into effect, which brings us to another complaint in the union presidents’ letter and something that should alarm anyone who cares about a constitutional government of laws not men. Obamacare gives the administration, particularly the secretary of health and human services, enormous powers. But this administration has not been satisfied with the powers that the law actually confers. The president has taken it upon
himself unilaterally to “waive” and even alter various provisions of the law.

Under our Constitution, the president of the United States is not supposed to pick and choose which laws he’s going to enforce. He may not amend, on his own motion, laws that Congress has duly passed. And yet repeatedly this president has simply decreed that he’s not going to enforce certain parts of Obamacare. He has unilaterally moved deadlines and changed criteria that are expressly written in the bill that Congress passed and he signed into law.

In their letter, the union presidents complained that the administration had made a “huge accommodation for the employer community” in moving back the deadline for the employer mandate to go into effect while refusing to grant waivers of provisions that were hurting union members, provisions that might even destroy their healthcare plans. The Democrats pose as the friends of blue collar workers. They’re supposed to be the unions’ champions. Greedy Republicans, in contrast, are supposed to care only about big business and the rich. But the reality of Obamacare is that it’s the Democrats who are stiffing workers.

Why are the Democrats catering to big corporations while making life more difficult for ordinary working people? The answer would seem to be that no matter how much they say they care about working Americans, the Democrats’ real priority is putting more of everyone’s lives under their control
because they know what is best for everyone. When that priority comes into conflict with the needs of ordinary Americans, grabbing more power always wins.

In Obamacare we’ve taken a huge step toward a European-style system of socialized healthcare for America. And we can’t afford it. How much fiscal sense does it make to force people like Charlene Hopkins, who was paying $276 a month for insurance she liked and could afford, onto Medicaid, where all her medical expenses will be billed to the taxpayers? In an even more absurd case, a retired Virginia man with a five-million-dollar home and three cars was told that Medicaid was his only Obamacare option. Forcing people who can afford to pay their own way into free government programs is the high road to national ruin. As Margaret Thatcher liked to say, the problem with socialism is that sooner or later you run out of other people’s money.

But that isn’t the only problem with big-government, top-down, centralized solutions, as Thatcher herself saw. She also argued that European-style socialism is immoral and corrupting. Obamacare is already turning independent citizens into the wards of the state—something our government has no right to do.

Nor does the government have the right to ration medicine, as it certainly will do once the expenses of this enormous new program begin to overrun the budget. Sarah Palin got a lot of flak for talking about “death panels,” but Howard Dean, the former chairman of the Democratic National Committee,
let the cat out of the bag, calling Obamacare’s Independent Payment Advisory Board (IPAB) “essentially a health-care rationing body” for Medicare patients: “The IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.”
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As the father of a special-needs little girl, Bella, I know all too well who will be the target of healthcare rationing: those whose lives are not worth spending money on—the chronically ill, the very old, and the severely disabled. The Democrats in Congress were so anxious to free IPAB from having to answer to future Congresses—and thus, in future elections, to the American people—that they wrote into the Obamacare law a blatantly unconstitutional provision that the part of the law creating IPAB could be repealed only in January 2017.

Obamacare goes against who we are as a free people. In the fight to repeal it and replace it with genuine reform, Republicans are solidly on the side of working Americans, who want to be responsible for their own families and help their fellow citizens in true need—not become helpless victims of a government-knows-best system.

CHAPTER EIGHT

INNOVATING AND PERSONALIZING EDUCATION

J
ames and Susan Harrison’s son Jason is sixteen, and his brother, Thomas, is fourteen. Both have grown up going to the local public schools, playing Little League baseball, and participating in community service and camping trips with their church youth group. The boys could be described as fairly typical kids for this part of the country. They follow the Cleveland Indians, play their music too loud, and spend a lot of time playing Madden, NBA 2K, and other video games. Jason and Thomas are bright kids and have done reasonably well in school, but so far they have not gotten the
high grades or test scores that would allow them to rely on scholarships to pay for college. Their parents think the boys haven’t been pushed or challenged much by their teachers.