By David M. Walker
Many are saying that the Supreme Court showed judicial restraint Thursday in its ruling on the Affordable Care Act. But the opposite is true—at least in one critical respect.
Historians will likely say that the court showed an astonishing level of judicial activism. While Chief Justice John Roberts sided with the more liberal justices and found the law constitutional under Congress’ power to tax, the bill would never have passed if the penalty had been cast as a tax increase. Many politicians, including President Barack Obama, went to great lengths to assert it was not a tax.
Yet several aspects of the Supreme Court’s decision do demonstrate restraint. Roberts joined four other conservative justices in finding the individual mandate unconstitutional under the Commerce Clause. As for Medicaid, he agreed to limit the federal government’s power to compel the states to expand their programs against their will.These decisions were appropriate, and represented an attempt to constrain the federal government’s growth and reach.
Reasonable people can differ, of course, and everyone is entitled to their opinion. Roberts’ opinion, however, happens to become the law of the land. Therefore, everyone is bound by it and we now need to discuss where we go from here.
Democrats must acknowledge that the law does not come close to dealing with the long-term fiscal challenges caused by rising health care costs. It may have increased coverage, but you can’t increase coverage and save money—that’s an oxymoron. In addition, both the Congressional Budget Office and the Office of the Chief Actuary of Medicare say that the health care law is likely to cost trillions more over time than its supporters claim.
On the flip side, Republicans now have a responsibility to put forth their plan for the future. After all, the United States does need to achieve universal health coverage that is appropriate, affordable and sustainable.
So what do we do? Here’s a four-point plan:
1. Focus on Needs Rather Than Wants.
We need to have a broader public conversation about what level of universal coverage the federal government should provide. Democrats obviously support universal coverage, since it was the ACA’s core purpose. It’s this point, however, that makes the GOP repeal argument fall flat.
If the Republicans and former Massachusetts Gov. Mitt Romney want to repeal the law, they need to decide how they’ll cover the millions of Americans who will gain insurance coverage under it.
The key is designing a system of universal coverage that covers only those things that are broad-based societal needs, rather than unlimited individual wants. A new reform law, for example, should cover basic wellness, preventive and catastrophic care only. Government needs to be able to deliver on what it promises.
2. Move Toward Evidence-Based Care.
We can accomplish affordable and effective universal coverage by moving to a more evidence-based system of care. The health reform act includes many provisions that try to achieve this. But real reform needs to (a) fast-track those initiatives; (b) find out which work and which don’t, and (c) quickly expand the best initiatives to the full health care system. In addition, tying both our medical payment systems and malpractice system to evidence-based standards could dramatically reduce costs and improve outcomes.
3. Create a Federal Budget for Health Care.Like all other major industrialized countries, we need to set a limit on the amount the government spends on health care. We write a blank check for health care — and it’s irrational and irresponsible to do so.
4. Increase Individual’s Financial Stake.
All of us have to take more responsibility — both for our own health and for the cost associated with it. The federal government now provides health care subsidies to people that are inappropriate and unaffordable. Frankly, these subsidies also encourage over-use of health services. We can no longer afford to exclude from taxation the entire cost of employer provided health insurance. Nor should the government subsidize 75 percent of the cost of Part B and D Medicare premiums for 95 percent of beneficiaries.
Now that the dust is settling from the court’s decision, let’s finally have an adult conversation about real health care reform. We can achieve meaningful health care reform in 2013 — possibly as part of a fiscal “grand bargain”. To do so, all options must be on the table and we must recognize that doing nothing is not an option.
It’s time to focus on positive reform rather than partisan rhetoric.
David M. Walker is former comptroller general of the United States and chief executive officer of the Comeback America Initiative.