Four paradoxes of health care reform: Conservatives can impose themselves morally and politically

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Polls show that Americans trust Democrats more than Republicans on health care than on any other issue. However, they also show that conservative healthcare solutions, such as price transparency and increasing choice and competition to lower prices, are popular.

This dynamic has led to a conventional wisdom within the center-right health care reform community — that Americans will end up trusting conservatives if we talk more about our market and state and local policies to make care and coverage more affordable.

We agree that conservatives shouldn’t shy away from discussing health care, but opinion polls our two organizations conducted this summer suggest that a message too focused on market fundamentalism and saving money will backfire. against them.

What Americans want from health care coverage is peace of mind.

First, while Americans support specific ideas for free-market health care reform, it will alienate voters if we talk about health care as if it were a typical commercial market. Indeed, health care is life and death – the stakes are too high for people to accept normal market dynamics.


For example, in health care, there is little notion of “luxury”. If a new treatment is more effective, it immediately becomes the standard of care. The idea that wealthy Americans can get better quality care than the middle class or the poor is contrary to what Americans expect from a health care system.

Second, Americans already think health insurance is too complicated, and the basic trade-off they are asked to make when choosing a plan, between paying higher premiums or exposing themselves to more financial risk , gives the impression of having to gamble with their health and that of their family. .

Ultimately, what Americans want from health care coverage is peace of mind. The idea of ​​more health insurance options and personalization could be seen as adding to their stress and confusion as well as exacerbating health care inequities if explained solely in terms of cost savings. money rather than making sure everyone gets the care they need.

Third, this desire for peace of mind in health care helps explain why, in our research, most Americans said they prefer laws and regulations to be set at the national level to ensure consistency and standards. Across the country. This is something we need to keep in mind when promoting national and local healthcare solutions.

Fourth, although Americans give our health care system low marks on most measures (quality of care being an exception), they place a high value on their individual care and coverage. As a result, there is little support for rapid, large-scale health care reform.

President Barack Obama and Vice President Joe Biden during the health care bill ceremony in the East Room of the White House, March 23, 2010.

President Barack Obama and Vice President Joe Biden during the health care bill ceremony in the East Room of the White House, March 23, 2010.
(AP Photo/J. Scott Applewhite, File)

So what are the conservatives supposed to do? The answer is not to abandon our principles and adopt the left-wing big government socialist approach to health care. Nor should we be timid and only propose marginal adjustments to the system.

Instead, conservatives should embrace the goal of ensuring that every American — regardless of income — receives affordable, high-quality health care and harness market forces to achieve this.

Fortunately, much of our agenda can be explained favorably in these terms. For example, the ObamaCare and Medicaid plans are notorious for their long wait times for appointments and tight provider networks that often miss out on the best doctors. Relaxing ObamaCare’s onerous coverage rules would allow plans to specialize, partner with centers of excellence and give more Americans coverage for the high-quality care they need. Making room for association health plans, cost sharing, and direct contracting options would also give more Americans the opportunity to get high-quality care at an affordable price.


The same is true with the reform of certificate of need laws that limit the number of health care providers in an area. We Conservatives tend to talk about reforming these laws to promote competition in order to lower prices. It should also be noted that it is the poorest Americans who suffer the most from the reduced number of providers, and a reform would allow more people to access care.

Conservatives can address the American people’s desire for consistency and standards in health care with clear national quality criteria, but allow state and local interpretation and enforcement to avoid one size fits all rules. Section 1332’s innovation waivers and the deference the Trump administration has given states in their response to COVID-19 provide possible models.

Conservatives should also adopt a strategy that we at America First Policy Institute have adopted, “radical incrementalism” – small but significant changes that, over time, add up to large-scale changes.


Price transparency in healthcare is a perfect example. It’s a problem with more than 90% favor that could radically change the convoluted system of third-party payment with all its intermediaries that increase costs and add confusion. However, it will do so organically and over time by patients and doctors making independent decisions, not through the plans of central planners in Washington.

The big government approach to health care is rife with failures that compound health inequities and lead to more confusion and frustration. Conservative health care solutions that put patients and doctors back in the driver’s seat are the cure for the mess created by big government. It is time for us Conservatives to take the moral and political lead on health care by emphasizing that our solutions not only save money, but more importantly, save lives.



Bobby Jindal was governor of Louisiana from 2008 to 2016 and a candidate for the 2016 Republican presidential nomination. He chairs the Center for a Healthy America at America First Policy Institute.

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