Newt Gingrich and John C. Goodman list Ten GOP Health Ideas for Obama. There's really too much to excerpt, so you'll have to read the whole thing for yourself.
My initial take: Some of these are very good ideas, some are less appealing. But whatever their individual merits, it's hard to see an overarching "vision thing" in the proposals. It is tinkering. Perhaps good tinkering, but it lacks a structural narrative that makes it easier to sell these as a package.
The GOP needs a much more comprehensive approach to entitlements in general, not just health care. At this point, I think we need to do one of two things: Either....
- Government as a Last Resort - Government can insure everybody for any yearly expenses over 20% of annual income, which completely eliminates the problem of unbearable costs, both for consumers and for insurers (and which ought to dramatically lower insurance costs, since the potential risk is far smaller). That shouldn't have a major distortive effect on the market, either, because most catastrophic costs tend to be things about which we can't/don't often make good cost/benefit calculations. This would also eliminate the need for Medicare/Medicaid, since this would automatically cover people who have little/no income. While there are undoubtedly problems with this, it seems on the whole better than a system that gets government involved at much lower decision and cost levels. Or...
- Government as a Safety Net - Restructure our entitlement system along the lines of what (if I recall correctly) Milton Friedman and Charles Murray have recommended: expand the EITC to cover basic costs of living on a means-tested basis, so we can predicate entitlements upon actual need, rather than blanket distribution.
In either case, I think you have a pretty strong, compelling message: Government should provide a safety net, not a straitjacket. We are not going to let people fail completely, but safety nets should not catch people who do not fall.
These options would allow Republicans to strengthen the safety net for people who genuinely need it, while making the program more sustainable by removing the "safety net" for people who don't actually need one. Importantly, this would also eliminate the "third rail" problem of entitlements, and we could actually begin making better cost/benefit decisions about them.
