For nearly five years, Republicans have been fighting to repeal President Obama’s healthcare law.
But repeal is not enough.
Even if simple repeal were politically obtainable, Americans would still be left with a broken healthcare system. Government regulations would still be stifling competition and individual choice and government healthcare programs would still be driving the nation’s unsustainable long-term debt problem.
If Republicans achieved repeal without agreeing on a way to reform healthcare along free market lines, it’s inevitable that Democrats would eventually lead another overhaul of the system that would grant even more power to the federal government than the Affordable Care Act does. This would gradually morph the system into a full single-payer program.
Republicans have been unable to unite around an alternative approach on healthcare so far. But this year, there are several factors that could force their hand.
The GOP now has full control of Congress, giving the party more power to set the policy agenda.
Additionally, the Republican presidential campaign will provide an opportunity for leading figures within the party to hash out ideological differences when it comes to healthcare policy.
Adding further urgency is that a Supreme Court decision expected by late June could invalidate Obamacare subsidies for millions of Americans. If Republicans don’t have an alternative ready, congressional leaders will be under tremendous pressure to pass a simple “fix” that would allow the subsidies to continue to flow, thus further entrenching Obamacare before a Republican president theoretically is able to act in 2017.
For these reasons and many others it’s important for Republicans to unite around an alternative to Obamacare. But that is easier said than done.
“People are always saying, ‘The Republicans have no replacement plans,’” Sally Pipes, president of the Pacific Research Institute, told me recently. “Well, the problem is they have too many plans.”
Internal divisions within the right of center policy community have prevented Republicans from unifying around a single approach to addressing healthcare. For that to change, the policy debate that has narrowly occurred within the conservative policy community needs to move outside of Washington.
In my new book, Overcoming Obamacare, I’ve tried to jump-start the conversation by taking the competing ideas that have been offered on the right for overhauling the healthcare system in the wake of Obamacare, and dividing them up into three schools of thought, or approaches.
The first approach comes from those who believe that fully repealing Obamacare is probably unrealistic, but who still see an opening to reform the overall healthcare system in a more market-oriented direction. I call this the Reform School.
The second approach comes from a crowd that believes full repeal is a necessity, but can only occur if opponents of the law create a market-friendly alternative with enough financial assistance to make health insurance widely available to those Americans who want to purchase it. I call this the Replace School.
And finally, there is a third approach, which advocates repealing the law, returning to pre-Obamacare levels of taxes and spending, and then using that clean slate as the basis to overhaul the system in a free market manner to bring down costs. I call this the Restart School.
As I explain in more detail in the book, each of these schools of thinking ultimately is based on a calculus, balancing political considerations against ideological beliefs concerning the proper role for the federal government in healthcare.
Though many of the disagreements within the right of center policy community seem difficult to bridge, the reality is that doing nothing will leave conservatives with the Obamacare status quo — or something even worse.
Philip Klein's new book, Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care is available in print and electronic editions at Amazon, Barnes & Noble, and Apple iBooks.