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Late in the game, Republicans are proposing alternatives to Democratic health care reform, but theyre certainly not being bold.
If they were, theyd follow the lead of Rep. Paul Ryan (R-Wis.), the partys foremost Jack Kemp-style conservative, whose Patients Choice Act aims for near-universal coverage without mandates.
Instead, to go along with incessant excoriating of Obamacare, House and Senate Republican leaders are proposing modest step by step cost-saving reforms that Democrats ought to consider, but wont.
Republicans will offer a single substitute bill in the House and multiple amendments in the Senate to show they arent, as Democrats charge, the party of no.
But its largely a charade. Senate Republicans clearly hope to delay health care reform into next year, build public opposition and frighten moderate Democrats away from the bill being drafted by Majority Leader Harry Reid (D-Nev.).
The unspoken intent is to sink President Barack Obamas signature initiative and send his poll ratings plunging, sparking big GOP victories in 2010.
All this does not exactly make the GOP the party of yes on health care. Ryans proposal would. Its designed to use state-regulated free-market competition and patient choice to lower health costs and cover nearly all Americans.
What scares his GOP colleagues is his big swap: Workers would pay taxes on their employer-provided insurance benefits, and everyone would get a tax credit to buy their own insurance in the private market.
In 2008, Obama clobbered Sen. John McCain (R-Ariz.) by charging that a similar idea was a tax increase on the middle class. McCain failed to defend it.
As Ryan told me, though, Were not raising peoples taxes. We are taking one tax benefit and swapping it out for a different tax benefit.
People at the bottom of the income scale do better under our plan than under the status quo and thats as it should be. The average American will get a $1,200 tax cut, and the most anyones taxes will increase is $300 for people in the top rate, who can afford it.
As Ryan points out, theres wide agreement across ideologies about the merit of eliminating the tax exclusion for employer-provided benefits and providing a tax credit.
Just Wednesday, Obamas budget director, Peter Orszag, was quoted in the Washington Post saying that changing that tax treatment is among the most important single things that could be done to constrain costs and improve quality.
Orszag has said it numerous times, but its not part of either Democratic or Republican proposals. Unions oppose it, and Republicans view it as too disruptive of a status quo in which people say they like the health coverage theyve got.
With more money in their pockets, Ryan says, people would be free to buy their own insurance, either the policy offered by their employer or some other and keep it if they changed jobs or lost their jobs.
Ryan proposes that each state develop an insurance exchange to organize the private market, but he would mandate that they offer the basic benefit now available to federal employees and Members of Congress.
Policies sold on state exchanges couldnt discriminate on the basis of pre-existing conditions, and states would prevent cherry-picking of healthy patients by having insurance companies risk-adjust share the risk for covering sicker patients.
Unlike most Republicans, Ryan shares Obamas view that the health care system in America is broken with costs rising at an unacceptable rate, both doctors and patients trapped by current insurance practices and 47 million people uninsured.
However, hes dead against the Democrats public option proposal. The federal government would run a health care system ... with the compassion of the IRS, the efficiency of the post office and the competence of Katrina, he says.
Ryan thinks that, even without an individual mandate, nearly everyone would sign up for some insurance plan possibly a high-deductible plan because states would make it convenient and cheap to do so.
House and Senate Republicans are offering some useful ideas. In the Senate, they will propose giving the uninsured and self-employed the same tax break that employer-insured workers get. House leaders think thats too expensive.
In both chambers, theyd reform Medicaid, crack down on Medicare fraud, cap malpractice awards, allow small businesses to form insurance pools and permit interstate purchase of insurance.
Democratic majorities will vote it all down, of course. And maybe Republicans can use public doubts to kill Obamacare. But then, as Ryan says, the U.S. health care system will continue to be broken.