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Build on Success


Health care is not on the agenda as a top issue in the new Congress, but it will leap forward and conservatives need to be prepared.

The House is expected to focus on COVID, especially investigating the source of the virus, vaccine harm, and the calamitous management of the pandemic by federal public health agencies.  Meanwhile, the Biden administration will proceed in as many ways as it can to drag more people into government health programs. 

House Republicans have pledged to control government spending toward the goal of achieving a balanced budget in 10 years. But they can’t hope to do that without addressing the pending insolvency of Medicare and the massive expansion of spending in Medicaid, which now has more than 90 million recipients.

The other side can cut the campaign ads right now—shoving granny off the cliff—to attack Republicans on “cutting Medicare.” They must take preemptive action.  

It’s important for seniors to know that Medicare must be changed to be saved and for young people to understand the gargantuan taxes they will have to pay as a result of today’s uncontrolled spending.

The issue must be addressed thoughtfully and carefully and not with across-the-board cuts.  The solution is improving the program to give consumers more choices in a properly functioning market where competition drives prices down—key to most of the problems in our health sector.

Two examples of popular and successful programs that rely on consumer choice and private competition should be the foundation of modernization efforts:  

  • In Medicare Advantage, private plans compete to offer more features than traditional Medicare. Seniors have flocked to the program, with nearly half – 28 million – now voluntarily enrolled.  
  • And Part D—the Medicare prescription drug program—is the only government health program to come in under budget, with premiums averaging about the same as they were when the program started in 2006—around $30 a month

Both programs need repairs and updates. But these hugely popular programs should serve as a foundation for reform to make the program more efficient.  

Tackling the unconscionable waste in Medicaid is another important target, but it again must be done carefully to stress the importance of the program in serving the most vulnerable.  First reform: Recipients should be able to use the value of their subsidy to choose private coverage if they prefer and thereby expand their access to physician care.  

None of this will be easy.  But it is vitally important to present a positive plan that builds on the successful programs Republicans have created.  The secret is consumer choice, private competition in a properly functioning and regulated market, while allowing government to focus on protecting the most vulnerable.

The Democrats’ solutions are predictable. They create new government programs and then build and build on them, pouring more and more taxpayer resources into expanding the programs to patch the many flaws—as they are doing now with Obamacare. Ever-rising costs and prices are hidden only because taxpayers are picking up more and more of the tab.  

These programs are quickly running out of other people’s money, and we must take a different approach. Instead of pouring more money into unreformed Medicare and Medicaid, we should build on what we know works by engaging private sector innovation and energy to make the programs better. 

And we mustbuild on successful programs to expand private sector options with Health Savings Accounts, Association Health Plans so small employers can get wholesale prices, boosting telemedicine, working with states to expand more affordable health insurance options, and giving employees access to Health Reimbursement Arrangements to gain more control and ownership over their coverage—for starters.


Grace-Marie Turner runs the Galen Institute, a public policy research organization that she founded in 1995 to promote an informed debate over free-market ideas for health reform.