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Solve the urgent healthcare problems, and leave the rest

Access, affordability and preexisting conditions can be handled by private companies.

September 20, 2009|Mickey Edwards | Mickey Edwards, a former member of the Republican leadership in Congress, is a vice president of the Aspen Institute and is working on a book about how political parties are undermining democracy.

Conservatives have made clear their opposition to President Obama's healthcare reforms. So does that mean they think the system works well as it is? We asked four prominent conservatives to think beyond their objections to the Democrats' ideas and propose ways to make the American healthcare system better.

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'I have had some bitter disappointments as president," Harry Truman wrote after he left the White House, "but the one that has troubled me most ... has been the failure to defeat the organized opposition to a national compulsory health insurance program."

Truman's national health insurance plan was sent to Congress in November 1945, nearly 64 years ago. His "failure" demonstrates just how long health reform advocates have been trying to fix a system they consider both ineffective and immoral. On the other hand, those six-plus decades of failure (in Truman's case, despite the fact that his own party controlled Congress for most of his presidency) also indicate how resistant Americans have been to such an expansion of the federal government's reach.

It probably should be clear by now that most Americans haven't embraced a sweeping remake of the entire healthcare system. But that doesn't mean there aren't holes in the current system that absolutely must be addressed. In fact, while one can make the case against "government medicine," to dismiss the issue altogether is not an option. There are problems, and some are severe.

The first involves affordability and access. Tying healthcare insurance to one's employer means that the unemployed, the self-employed and the employees of very small companies find it very difficult and/or very costly to buy insurance protection.

The second is the difficulty in buying coverage for those events most likely to occur; I would have no problem finding somebody willing to insure me against being hit by a meteor, but if I have a known susceptibility to something more serious, maybe something that has previously afflicted me, I will find few companies willing to help with the costs should that problem occur again. Insurance companies like to portray themselves as firms that assume risk in exchange for whatever profit they can earn as the risk is spread over time and populations. Modern health insurers, however, much prefer to maximize profit by minimizing the risk they assume. In other words, they prefer to insure us against things that are unlikely to happen.

These two overarching problems must be dealt with. So let's focus on the urgent, not on the (to some) desirable.

Step one: Authorize creation of an alternative, non-government source of insurance -- a "pool" that would allow the uninsured, self-insured, etc., to join in a private plan that would not be tied to any particular employer or association. This plan already has a great deal of bipartisan support and could easily be brought to life.

Step two: Corporations are creatures of government, provided with special government protections against the kinds of liability that plain citizens might face in providing goods or services. All "government creations" (radio and television stations using the public airwaves, for example) face certain restrictions as a price for the government benefit they receive. While insurance companies might have to charge more for covering an event that is very likely to occur (increasing the insurer's risk), they could, as government-empowered entities, be required to insure those with preexisting conditions and cover any recurrences or ongoing problems linked to those conditions.

These two steps would address the most urgent of the problems in the healthcare system without getting bogged down in the attempt at the complete remake that so many Americans resist.

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