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After Obamacare

The opinions expressed by columnists are their own and do not necessarily represent the views of

Who should be in charge of your health care – you, or the government? That, in a nutshell, is what the debate over Obamacare is about.

True health care reform is needed. Unfortunately, the president’s signature law is the wrong medicine. Which is why, if the Supreme Court affirms that the law is unconstitutional and overturns it, we shouldn’t consider the problem solved. Not at all. We will simply have stopped applying a treatment that was making the problem worse.


One of the main ways it’s doing so: financially. Right now, health care spending amounts to about one-sixth of the economy. Estimates from the Congressional Budget Office show this amount is climbing rapidly. In fact, by the end of this decade, it will reach a point where it’s consuming one-fifth of the economy -- and continue to grow from there.

This is obviously unsustainable. The fact that Obamacare makes this day of reckoning come that much sooner is reason enough to jettison the law.

<>But this necessary first step is just that: a first step. Once Obamacare has joined the growing pile of failed government-heavy prescriptions, we need to prescribe the correct remedy. In addition to Medicare premium support, which we at The Heritage Foundation outline in our reform plan (, we need to do the following:

Create a new health care tax credit. We can trace much of the dysfunction in the current health care system to how most people get their insurance: through their workplace. The money that’s spent on your health care is a tax-free benefit. But this means you’re stuck with whatever coverage your employer offers, whether it’s right for you or not. And if you want to (or have to) buy your plan, whatever money you spend on it doesn’t enjoy the same tax-free status.


What we need to do instead is to ensure that Americans, regardless of job situation, are eligible for a tax credit or other help that can be used to purchase health insurance. This would allow people to buy, own and keep the plan of their choice.

Under the Heritage plan, the net value of the credit would be $2,000 for an individual and $3,500 for a couple or family. This credit would be gradually phased out for those with higher incomes.

Offer assistance to lower-income working families. We need to help poor Americans get the coverage they need -- and it should be paid for with cuts in other health care spending. This way, we wouldn’t have to push still more low-income able-bodied adults and their families into the costly and failing Medicaid system, as Obamacare does.

Instead, they could enroll in a private plan of their own choosing, just as the rest of society does. They’d be able to get the kind of coverage they want, not the kind the government wants them to have. And under the Heritage plan, low-income individuals would receive the financial assistance they need to buy health coverage as well.

Restructure Medicaid. We need to turn Medicaid into a true safety-net program, not the catch-all, patchwork one we have today, where you need a new “part” every few years to work around flaws in the system. The Heritage plan would convert federal spending on acute and long-term care into a capped allotment to the state for the disabled and elderly.


States, meanwhile, would get the flexibility they need to administer the reformed program as they see fit. Rather than be micro-managed, they could meet federal objectives in whatever manner works best for them.

Unless we take the kind of steps outlined above, and encourage true market-based reforms, the prognosis for American health care will remain negative. We need a real market, one in which you and your family can find, buy and keep the health coverage you want. Obamacare doesn’t offer that. The Heritage plan does.

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