Matt Miller - The Archives

Reviving the GOP in one easy step
The Washington Post, January 30, 2013

I'm not generally in the business of giving advice to the Republican Party, but when you see people suffering with no self-awareness or plausible path to recovery, an intervention is in order.

Since the election and their subsequent fiscal-cliff and debt-ceiling retreats, Republicans have been flailing, even as "rising stars" such as Bobby Jindal and Marco Rubio offer messaging tweaks rather than policy adjustments. So let me reveal a sure-fire way for a Republican governor to grab the national spotlight, earn a reputation as a problem-solving innovator and help the GOP seize the political center in ways that honor conservative values.

A return to pragmatism?

All that Republican governor has to do is this: Ask the Obama administration for a waiver to Obamacare that lets him or her implement universal catastrophic health coverage in his or her state.

Let me explain why this call to "mend, not end" Obamacare would be great policy and better politics for Republicans (and good for the country as well).

First, let's look at how the policy would work. Catastrophic coverage means that after a certain deductible, all medical expenses would be covered by insurance. Usually when conservatives peddle such high-deductible plans they make a fatal mistake: They fail to limit out-of-pocket expenses to some reasonable share of family income. A $5,000 deductible for a family earning $22,000 doesn't make sense. So this GOP plan would define "catastrophic" relative to income.

The other typical flaw with catastrophic plans is that people don't get the preventive care they need. So you need to make sure everyone can afford such care—either via pre-funded health savings accounts for those with modest incomes or by subsidizing some version of the emerging "fitness club" model of primary and preventive care, in which members pay, say, $65 a month for access to these services (with no insurer involved at all).

This brand of reform has a solid Republican pedigree. Former Treasury secretary Paul O'Neill pushed a version of universal catastrophic coverage when he worked at the Office of Management and Budget in the 1970s. A smart update of the concept was laid out by Dana Goldman and Kip Hagopian in the fall 2012 issue of National Affairs (the "it" journal edited by Yuval Levin for conservative wonks).

Our GOP leader would ask Health and Human Services for permission to consolidate all federal monies now coming to his or her state for nonelderly health care—including Medicaid, the new Obamacare subsidies and, ideally, the cost of the current tax subsidy for employer-provided care—to fund the universal catastrophic plan. (Regulations say such waivers can't be sought until 2017, but in Washington everything's negotiable.)

The GOP plan would also replace today's malpractice litigation lottery with a system that protects doctors from liability so long as they've followed evidence-based best practices. This would put an end to the "defensive medicine" that runs up costs—a common-sense reform that Democrats reject as a sop to the trial lawyers who fund their campaigns.