The Daily Item, Sunbury, PA

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November 9, 2013

Health law's defects the price of bad politics

(Continued)

No more means testing, no more tax relief for employer- based plans. Medicaid, Medicare and other government programs would be phased out and folded into the plan. A dedicated sales tax would pay for it all, providing a strong and visible check on costs.

A proposal of this kind was introduced 10 years ago by Victor Fuchs and Ezekiel Emanuel, and described by Emanuel in his book, "Healthcare, Guaranteed," which I recommend if you're curious to see the idea developed in more detail. Emanuel has been an adviser to the Obama administration and has lately been seen on television haplessly defending its efforts — but don't let that put you off. Chapter 6, "The Mistake of Mandates," explains why the system he's now obliged to advocate for is likely to fall short.

Is there any point in even thinking about such radical alternatives while U.S. politics are mired in the reality of Obamacare? Perhaps not. Until further notice, Democrats will be engaged in damage control, and Republicans show no interest in advancing a plan of their own. It would take a much braver administration than this one to champion such an undertaking, not to mention a semi-functioning Congress to pass the legislation. Brave presidents, purposeful legislators — these both seem very remote.

For now, a better model at least gives us a good benchmark for judging what we have. And I wouldn't write the idea off altogether. Obamacare's defects ensure that the topic isn't going away.

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