By Joseph Rago
Tom Coburn stood for Congress in 1994 as a political tenderfoot for two main reasons: As an obstetrician he thought government was impinging too much on his medical practice, and the nine-term House Democrat who held his Oklahoma district's seat favored the Clinton national health plan then under consideration. Another reason Dr. Coburn entered the race, he says, was that "the cowardice of career politicians governing to win the next election above all else made me sick." Twenty years later, he finds himself amid another health-care scrimmage—and in a similar political climate.
"It's no better today. It's still here. It's worse," says the junior senator from Oklahoma, sitting in a wing chair in his Capitol Hill office earlier this week. His prairie timbre is flecked with the contempt of overfamiliarity.
Editorial board member Joe Rago on the politics of a new Republican plan to deregulate the nation's health-care market. Photo: Getty Images
"I don't think Washington can fix Washington," Dr. Coburn explains. "You're always going to have this built-in conflict of getting re-elected. Parochial interests will trump the best interests of the nation, and the actors will do what's expedient to be popular. It doesn't have to be that way. There's hundreds of thousands if not millions of people who could do these jobs well. All it requires is common sense and courage."
Those qualities will be appreciably diminished in Washington when Dr. Coburn retires at year's end. He is among Washington's few true conviction politicians—unalterably against federal debt, government waste and the abuse of power. He genuinely doesn't seem to care about being popular, or endearing himself to anyone; lately he has even grown a night-of-the-wolfman beard that is decidedly out of Beltway fashion.
Dr. Coburn was recently diagnosed with a recurrence of prostate cancer, which is why he is leaving before his term officially expires in 2016, but he still has work to do. Even if he has failed to change a political culture of self-interest and careerism, the doctor from Muskogee can still challenge his nominal party, the Republicans. This week, he and two colleagues released an ObamaCare replacement plan that offers innovative—and consequential—pro-market health-care reforms, intellectually akin to Paul Ryan's 2011 Medicare proposal.
"Everybody in the country knows what Republicans are against," Dr. Coburn says—namely, ObamaCare. "No, what we have to do is make sure Americans know what we're for. The whole idea is to empower patients, not bureaucracies, and to empower markets, not rely on market manipulation and mandates."
Few conservatives would disagree, but the GOP has been notably diffident and risk-averse on substance. Dr. Coburn observes that "nearly all the economists agree" that a source of America's long-running health-care dysfunctions is the tax exclusion for employer-sponsored insurance only. Like the company store, this open-ended subsidy makes it cheaper for businesses to compensate workers with in-kind benefits rather than with taxable higher cash wages.
Patients are thus insulated from choices about prices and value, but as a result price signals are suppressed and consumers end up paying more. And because this inefficient and regressive subsidy costs $250 billion a year in foregone revenue but doesn't flow to the individual market, it's scandalously unfair to people who don't get coverage through their jobs.
So far, so economically conventional. But politically, touching the insurance exclusion for businesses is dicey, as Republicans witnessed when John McCain was brutalized in 2008 for proposing to convert the exclusion into a universal flat tax credit for individuals, regardless of age, income or employment status. Such a reform could lead to disruptions as businesses shed coverage, and the Obama campaign savaged the McCain plan as a middle-class tax increase. Republicans in Washington have also followed the ObamaCare rollout and concluded (correctly) that voters don't like losing their insurance and doctors, especially amid false promises they could keep both.
The Republican majority, eager to oppose ObamaCare but wary of political tiger pits, has relied on championing "repeal and replace," details to come. Or pretending that U.S. health care was a free-market Shangri-La until the Affordable Care Act came along. Or resorting to self-destructive stunts like shutting down the government in the name of "defunding" ObamaCare.
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