Dismantling Big Government One Step at a Time

Posted: Aug 15, 2014 12:10 PM

Avik Roy, a senior fellow at the conservative Manhattan Institute, has released a new health care reform plan titled, "Transcending Obamacare." National Review's Callie Gable has a good summary of the 68-page proposal here.

In short, Roy's plan would:

  1. Repeal the employer and individual mandates
  2. Eliminate many of the regulations on health insurance plans thus making low-cost, high-deductible plans available
  3. Repeal most Obamacare taxes
  4. Move most Medicaid recipients onto health exchanges as well as some Medicare enrollees
  5. Decrease monopoly hospital power by making new hospital construction easier and encouraging more federal antitrust law enforcement

Some conservatives will oppose Roy's plan since it does not begin by repealing Obamacare. But, as I have argued in the past, conservatives should not make the perfect the enemy of the good. The American health care system was broken before Obama tried to fix it and fetishizing full repeal at the expense of smaller, more popular, reforms would be a huge mistake.

Writing at The Federalist, Texas Public Policy Foundation health care policy analyst John Davidson agrees:

The truth is, Obamacare didn’t create something new or innovative so much as radically double down on some of the worst aspects of existing health care policy—increasing government control over private health insurance, expanding the Medicaid entitlement, and cooking up a witch’s brew of new taxes and mandates.


To be sure, conservatives will find a lot to complain about in all of this, and not just because it doesn’t repeal every piece of Obamacare. In some areas, it continues to rely on government funding for healthcare, which for some people is and always will be unacceptable. But what’s much more important—and this is what Roy gets right in a way that no one else has yet—is that the plan addresses, in a substantive way, those features of the American health care system that have been driving up the cost of care, and eroding its quality, for half a century.

Progressives did not create the modern welfare state in one fell swoop. They did it by incrementally building it up over time. Conservatives should steal a page from their playbook and begin to cut the size and scope of the federal government whenever they can.

If we wait to do at all at once, we may be waiting forever.