Three Schools of ObamaCare Reform


Like-minded people can often disagree. Opponents of ObamaCare all want a better healthcare system. But they disagree on the best way to achieve their common goal.

A new book called Overcoming ObamaCare by Philip Klein discusses what he refers to as the three schools of thought on ObamaCare reform. He calls them The Reform School, The Replace School, and The Restart School.

All agree that repeal alone is not an option. Going back to the system we had before ObamaCare without modifications is unacceptable to the American people. Therefore, all three schools seek to improve on the old system as well as ObamaCare. All three seek to move America in a more market-oriented direction.

The Reform School

Those in this school believe it is unrealistic to expect a full repeal of ObamaCare and therefore seek to improve upon the present with market-oriented reforms. They believe they can tweak the system without the need for a political majority that would support repeal.

Republicans currently control both houses of Congress but would need some bipartisan support, nevertheless, to pass any major changes to Obama’s signature legislation. It is likely he would veto any change that does not have significant Democratic support.

Changes could be made in a series of small pieces of legislation or a large overhaul bill that seeks major change. Possible changes include eliminating unpopular mandates that force individuals and employers to purchase health insurance and lowering taxes on medical device manufacturers that inhibit innovation and eliminate jobs.

Advocates of the Reform School approach include Grace-Marie Turner, founder of The Galen Institute, and Avik Roy, fellow at The Manhattan Institute. Roy’s alternative approach is called Transcending ObamaCare and has been discussed in this blog in earlier posts. Both call for changes in ObamaCare that would not require full repeal of the law – and therefore may be more achievable.

Opponents of this approach believe that gutting ObamaCare is necessary to eliminating the perverse incentives in the law that restrict freedom of choice and unnecessarily drive up the cost. Furthermore, they believe that this approach to change would allow future liberal administrations to undo the changes easily and restore the original intentions of government control found in ObamaCare.

The Replace School

Those in this school believe ObamaCare is so fundamentally flawed that it cannot be fixed and must be replaced with a better alternative. They believe that tweaking the law with changes around the fringes will fail to achieve the desired goals of freedom of choice, improved healthcare, and fiscal responsibility.

Advocates of this approach include Jeffrey H. Anderson of The 2017 Project and James Capretta of The Ethics and Public Policy Center and The American Enterprise Institute. They believe a politically viable replacement plan must account for ObamaCare’s beneficiaries by providing a suitable alternative. “I don’t think it’s politically viable to say you’re going to yank people back off coverage and have no answer for that,” said Anderson.

The 2017 Project plan has also been reviewed in this blog in the past (Alternatives to Replace, Not ‘Fix’, ObamaCare). It calls for refundable tax credits that allow everyone to receive federal assistance to purchase health insurance regardless of their income level or taxes paid. Furthermore, by eliminating mandates that restrict freedom of choice and drive up the cost of insurance, they will save money for both the government and the consumer. This plan was advocated by Senate candidate Ed Gillespie in the 2014 Virginia senate race and he almost pulled off the biggest upset of the night.

The Burr-Hatch-Upton bill introduced recently would also fall in The Replace School. This plan was reviewed in Republicans Push Patient CARE II to Replace ObamaCare.

The Restart School

A third approach is advocated by those who believe we should start over with no attempt to build upon the lessons of ObamaCare. These advocates want to create a new healthcare system as if it is 2009 and ObamaCare never happened. Included in this school are Governor Bobby Jindal of Louisiana and Rep. Paul Ryan, current Chairman of the House Ways and Means Committee.

They want to craft a plan that doesn’t attempt to match the insurance coverage of ObamaCare nor measure its cost by comparing to the cost of ObamaCare. They believe this would only ensure we have another unaffordable entitlement like Medicare and Social Security.

Jindal’s plan uses tax deductions for all taxpayers who purchase health insurance rather than tax credits like the 2017 Project and Burr-Hatch-Upton. The deduction could be applied to both income and payroll taxes. He would expand the use of Health Savings Accounts (HSAs) and allow selling of insurance across state lines.

Opponents of this approach worry about the disruption of the employer-provided insurance market that covers about 160 million Americans. Also, tax deductions are unlikely to cover as many of the uninsured. It is also unclear how this approach would deal with the issue of pre-existing medical conditions – one of the few popular parts of ObamaCare.

However, nearly everyone can agree it was unnecessary for the government to disrupt healthcare for everyone to solve a problem that only affected about 1% of the population. Jindal argues his approach would be “the least intrusive, best way to legitimately help those with pre-existing conditions rather than upsetting the entire apple cart of private insurance the way the president’s plan does.”

Three different schools of thought – reform, replace, restart – but with one common goal. Provide Americans with a better healthcare system than ObamaCare. Republicans will have to come to a consensus soon if they are to present a unified message to provide an alternative before the 2016 elections.


(Note: To listen to a panel discussion of these three schools click on the link to Overcoming ObamaCare: Three Approaches to Reversing the Government Takeover of Health Care.)

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