Bill Clinton raised some eyebrows on the campaign trail Monday when he declared that Obamacare “is the craziest thing in the world.” He assailed the law for escalating health care costs and decreasing health plan choices amongst middle-income Americans. The critique of Obamacare, which was entirely accurate, was surprising particularly because it puts his wife — an ardent defender of the law — in an awkward political position going into Sunday’s second presidential debate.
Perhaps even more surprising has been the fact that Donald Trump hasn’t more directly and forcefully used this same line of attack against Obamacare and, by extension, Hillary Clinton. In fact, Trump failed to mention Obamacare’s failings even once during the last week’s presidential debate. Anyone involved in Trump’s debate preparations for this weekend’s matchup should ensure that he does not allow the entirety of another debate to pass without some mention of Obamacare’s shortcomings.
Bill Clinton’s defenders have argued that his comments about Obamacare were taken out of context; that what he was actually advocating for was the need for changes to be made to the law so that it functions more effectively.
The problem isn’t that the health care law needs to be tweaked, or that the rising premiums and declining choices that consumers face are surprises that require a course-correction. Indeed, the law was so poorly designed and conceived that these problems were entirely predictable.
While Clinton was right about the challenges created by the law, he was wrong about the way forward.
One of Obamacare’s core failings is its overt reliance on young or healthy consumers to sign up for health insurance under the law and thereby subsidize the costs of the old and sick. That generally hasn’t happened, so everyone’s premiums have risen to compensate for this mismatch of risk. Hillary (and Bill) Clinton’s solution to the problem is to offer everyone the opportunity to buy into a “public option” for health insurance — essentially, a health plan underwritten and operated by the government that would be more affordable than private plan options currently available on the law’s marketplaces.
But such a proposal only shifts risk away from the private sector and into the hands (and wallets) of taxpayers. If the old and sick continue to sign up for health insurance at a more rapid pace than the young or healthy, it’s not insurance companies who will be left to pay the bill — because government is the insurer in a “public option” health plan. That means taxpayers are the ones ultimately on the hook if the plan fails or doesn’t operate as expected.
There is a better way than what Clinton proposes. Part of the answer is to lower premiums by providing consumers with a wider choice of health plan designs, so that people can pick the plans that better suit their needs — rather than the one-size-fits-all plan structure currently mandated by Obamacare.
More broadly, policymakers should turn the page on Obamacare by pursuing fundamental health reforms that empower citizens to make health care decisions, migrate government subsidies for health care toward defined contribution payments, and incentivize innovation and payment for performance in the provision of heath care. Speaker Paul Ryan’s “Better Way” agenda includes a replacement for the Affordable Care Act that would do just this.
Bill Clinton started an important discussion about the failings of Obamacare and the need for reforms of the law. The question is whether Republican candidates like Trump will seize the opportunity to press Democrats on their continued support for Obamacare and, more importantly, to present a better alternative of their own.