The Supreme Court's high-profile decision to sustain the individual mandate in the Affordable Care Act hasn't ended the debate on the law's merits.
Instead, it has set up a high-profile battle for the White House — with the president's health care law right in the middle.
Even proponents of "Obamacare" admit that the legislation initially will increase our country's spending on health care, and that many Americans will see premiums rise.
But if conservatives overwhelmingly carry the election in November with a mandate to repeal the ACA, they also need a plan to replace it.
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Our nation's health care system was riddled with problems before the act, and those problems are still with us today. The biggest single problem with our health care system is that it links private health care coverage to employment, leaving people who lose their job — or who are in low-paying jobs — without insurance.
The current tax structure favors employer-provided plans, which includes coverage for ordinary expenses (such as office visits), making insurance and health care services very expensive.
Instead of an employer-provided model, we should encourage market-based health care options that keep costs low, quality high and increase plan portability and access. This, by itself, will enable most everyone to acquire affordable and high-quality insurance and health care.
It's a broad goal, so here's how you put it in to practice. Lawmakers should start by enabling interstate purchase of health insurance in order to increase competition and drive down rates.
The government ought to make individual plans tax-exempt to create a market that's more competitive and that offers a wider variety of plans tailored to people of all ages and lifestyles.
For instance, many healthy people might prefer a stripped-down health care plan with a high deductible and a low premium. Under such a plan, individuals would pay most everyday health care expenses out-of-pocket, while still being assured coverage in the event of a major medical catastrophe. These plans encourage the careful use of health care services, therefore keeping premiums low.
This plan is similar to those we buy for our cars; we're covered for major accidents but not oil changes.
Of course, the individual market would also feature plans with a broader base of coverage, as well as plans with guaranteed renewability at group-average rates for those who develop chronic illnesses.
For individuals and families who struggle with health care costs, programs for assistance in purchasing private plans can be devised, with the assistance based on income and health status.
The nearly uniform insurance pricing scheme adopted under the Affordable Care Act works against providing incentives to adopt healthful behaviors. In a competitive market, plans can tie premiums to health and wellness activities, thereby encouraging healthy habits.
By allowing individual rating of health insurance premiums, insurers can also reward those who engage in, for example, diet and exercise programs to decrease their risk of diabetes and heart disease and decrease long-term health care costs associated with obesity-related illnesses.
These fundamental changes to the health care market represent the largest needed reforms, but they're hardly the only important ones.
Policymakers should also remove insurance regulations that mandate laundry lists of coverage.
These mandated benefits drive up the price of insurance and prevent consumers from acquiring the coverage that suits them best. It might be stating the obvious, but not everyone needs coverage for things like birth control and substance-abuse treatments.
Additionally, states should examine scope-of-practice laws that put onerous restrictions on the duties of able practitioners such as physician assistants and nurse practitioners.
Expanding access to these skilled health professionals will allow more individuals to seek treatment without overwhelming the dwindling number of primary-care physicians.
Proponents of Obamacare are claiming victory from the Supreme Court's decision, but a true victory requires fixing the problems that existed before — which the law fails to do.
Let's steer the national dialogue away from the Supreme Court and towards making real reforms to our country's ailing health-care system.