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RYAN/NUNES: Let the debate begin

By Rep. Paul D. Ryan and Rep. Devin Nunes | Monday, June 8, 2009


Halfway through 2009, the Obama administration and the Democratic majority in Congress seem to have forgotten that the 2008 election is over. 

Hoping that rhetoric and promises can continue to substitute for substance, Democrats remain stuck in campaign mode on an issue that requires an open and thorough debate: health care reform. Their promise of date-certain results on universal health care lacks one critical component: a legislative proposal. 

While it is within the majority’s power to ignore the Republican minority, a group of people that shouldn’t be ignored are the American people. The closed-door internal debate — focused mainly on the insistence of a government-run “option” and what current (or future) Americans will be taxed to pay for it — is a debate they’ve calculated is too risky to hold in public view. 

It is not an unwise strategy, as it would be difficult to reconcile the administration’s and the majority’s rhetoric with their oft-discussed (but not yet introduced) new gov- ernment health entitlement or their oft-discussed (but not yet introduced) federalization of health insurance with stifling mandates. You can’t create a public program — where the government serves as both the referee and the player in the game – setting up a stacked deck where private insurers would quickly dump 120 million Americans onto government insurance — and call that greater choice and fair competition. 

You can’t expand choice by restricting it with endless mandates and dictates from Washington. You can’t create new government entitlements, impose trillions of dollars of new taxes, and call this cost containment. 

The expectation was that Democrats in Washington would emerge from their secret meeting rooms and tell the American people: Allow the government to take over the management of health care or continue with the failed status-quo of today. This is a false choice. Along with our fellow Republican Sens. Tom Coburn (a doctor of medicine) of Oklahoma and Richard M. Burr of North Carolina, we have proposed a comprehensive, innovative plan that reorients health care around the individual, not the government. 

The Patients’ Choice Act of 2009 (S. 1099/H.R. 2520) demonstrates we can have universal health insurance in this country without the government taking it over. 

We agree with the stated goals of both political parties when it comes to health care reform: tackling the fundamental drivers of exploding costs; empowering patients and providers with greater choice and competition; and ensuring access to quality, affordable health coverage for all Americans. The difference is that we actually accomplish these goals. It is irresponsible to promise such things without clearly articulating how to achieve them. 

The problem is not that we don’t spend enough money, but that we don’t spend it efficiently or effectively. The federal government spends about $200 billion each year funding a discriminatory tax policy for those who receive health insurance through their employer. Those who don’t have employer-provided health insurance, or who are unemployed, receive no tax benefit. Our proposal replaces this income tax exclusion with an advanceable, refundable tax credit for all Americans to buy portable health insurance. 

We continue to encourage businesses to offer health insurance by allowing the current tax incentives for businesses to remain intact. So if you like what you have, you can keep it – but it will be your decision. 

The proposed Patients’ Choice Act also would reform the second-class care for society’s most vulnerable by converting the broken Medicaid program from a defined benefit to a defined contribution program. In addition to the universal tax credit, Medicaid beneficiaries would receive additional resources to pay for health care. 

To ensure affordable, quality coverage for all, we propose real insurance reforms that reorient the incentives of these companies so that they jibe with patients. Our bill encourages state-based solutions – in the form of voluntary health exchanges. These exchanges will prevent cherry-picking against those deemed uninsurable and will be made possible with risk adjustment mechanisms and other state-level options such as reinsurance and risk pools. We also include common-sense reforms to expand coverage through auto-enrollment for individuals who do not select a plan at the start of the year. 

To ensure that market forces can actually work in health care, patients must know what services cost and who provides the best service. We propose an industry-based Healthcare Services Commission that will bring much-needed transparency to the currently opaque health care market. 

This comprehensive reform legislation includes concrete prevention and wellness initiatives, health information technology, long overdue entitlement reforms, and more. 

All the reforms in this legislation demonstrate a clear, coherent path to achieving universal access to quality, affordable health care with the patient and the doctor – not the government or insurance companies – as the nucleus of health care in America. 

We could not agree more with President Obama: Reforming our health care system is no longer an option; it is a necessity. The Patients’ Choice Act is a real proposal with real legislative text and real solutions. 

We believe it is irresponsible to simply criticize without offering a better path forward – for both the American people and our colleagues in Congress to read, scrutinize and debate. This cannot be a one-sided discussion. We hope the majority soon gets over the fear of its own ideas and engages in a health care debate the American people deserve. 

Rep. Paul D. Ryan, Wisconsin Republican, and Rep. Devin Nunes, California Republican, are both members of the House Budget Committee and the Ways and Means Committee.

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