cover to dump their health insurance altogether, because the expenses are getting so high. That was said by an executive at one of the large tech companies—that he is hearing from his peers at other companies that as long as there’s any credible place to push their employees, big companies are getting ready to dump their health insurance coverage. I mean, this thing isn’t working.”
If that’s true, I observed, then presumably the people who lose coverage through their employer will be able to get coverage through the exchanges, so they’re not actually going to lose coverage altogether.
“Yes,” agreed Cruz, “But it’s interesting. Another one, a different exec at one of the high-tech companies, said his employees had been coming and saying, ‘We really like our health insurance, what we have that our company provides, can you promise that we’ll be able to keep it?’ And he said he’s having to tell them, ‘No, I can’t promise you that; the costs are going up so high.’ I mean, his perspective is, as Obamacare forces more and more people to be thrown off their health insurance coverage, or lose coverage, that it’s all headed towards single payer, to a government-provided, single-payer, socialized health care system.”
I asked for clarification.
“I understood him to mean,” Cruz said, “that as private insurance became less and less affordable and accessible, the only option that would be left is for the government to step in and provide government-provided socialized medicine--that that’s where this is headed.”
I told Cruz that, from my perspective, he’s lucky. As a member of the Senate’s minority party, he can oppose Obamacare all day long, without being expected to offer an alternative. Still, though, what would his alternative be?
“I think there’s a real need for health-care reform,” said Cruz. “The first priority is to defund and repeal every word of Obamacare, because it’s not working, because it’s killing jobs, because it’s driving up health insurance premiums, because it’s hurting the American people. Once that’s done I think we need serious health care reform, and I think that reform should follow a couple of key principles.”
Cruz then launched into an epic soliloquy, with basically no interruptions, dysfluencies, or rhetorical cul-de-sacs.
“Number one: it should expand competition and use of the marketplace. Number two: it should empower consumers to exercise choice to meet their health-care needs. And number three: it should disempower government bureaucrats to second-guess and get in between doctors and their patients in making health-care decisions. Those are all general principles. Now let me give three specific policy proposals that are manifestations of those principles.”
“Number one: I think we should allow people to purchase health insurance across state lines. Right now it’s illegal to do so. What that would do is create a true, fifty-state, national marketplace for health insurance. Right now, the biggest barrier to health insurance for many of the uninsured is the cost—that health insurance is very, very expensive. And a significant reason health insurance is so expensive is because of all the bells and whistles that are mandated by government. If we had a true, fifty-state marketplace, what we would see is the widespread availability of low-cost, catastrophic health insurance policies, which would expand coverage dramatically, because the costs would fall and they would be far more accessible to people who can’t afford it right now. That’s number one.”
“Number two: we need to significantly expand the use of health savings accounts, so that people can save, in a tax-advantaged way, for prevention, for routine health maintenance, for challenges that are short of catastrophic, but nonetheless health-care needs that people have.”
“And number three: we need to work to delink health insurance from employment. As you know, it is an historical accident that health insurance is typically tied to employment. It actually arose during World War II and shortly thereafter, when wage and price controls were in effect, and employers were unable to recruit employees using higher salaries, and so they began using health insurance and other perks as ways to recruit new employees.”
“Right now,” Cruz continued, “If you or I lose our jobs, we don’t lose our car insurance. We don’t lose our life insurance. We don’t lose our house insurance. There’s no reason on earth we should lose our health insurance. And of all of them, I think health insurance is the worst one to lose. And so we need to change federal law to make health insurance policies portable and personal. So just like with your car insurance, if you leave your current job and go on to another one, you take your car insurance with you. And that change goes a long long way to solving the problem of pre-existing conditions, because pre-existing conditions become a major barrier to health care when someone loses their job and then have to get a new policy, rather than if they are able to maintain their policy throughout.”
“Now, the difference between those three specific proposals and the approach of Obamacare,” added Cruz, “is Obamacare relies on central planning, on the federal government interposing its judgment into the middle of decisions between doctors and patients. And I think the right approach is exactly the opposite: we should empower patients, we should empower individuals, to take control of their own health-care decisions.”
This plan has a few problems, or, to put it another way, doesn’t solve some of the key issues with the status quo that prompted Obama and the Democrats to pursue health-care reform in the first place. First, some people are uninsured because private insurance companies are reluctant, if not outright unwilling, to insure them. That makes sense from a market perspective, but it’s a cruel situation for people in question and their loved ones, not to mention burdensome for the hospitals that have to absorb the cost of uninsured care, and so on. (Cruz had implicitly addressed this earlier, with his comment that the problem of pre-existing conditions often