Skip to main content

The real problems with Obamacare

By David Frum, CNN Contributor
September 17, 2013 -- Updated 1048 GMT (1848 HKT)
STORY HIGHLIGHTS
  • David Frum: GOP effort to defund Obama's health plan is going nowhere
  • He says it makes more sense to focus on the key flaws of Obamacare
  • Republicans should push to make sure the plan has cost-control features, he says
  • He says it makes sense to broaden funding so most Americans pay for it

Editor's note: David Frum, a CNN contributor, is a contributing editor at The Daily Beast. He is the author of eight books, including a new novel, "Patriots," and a postelection e-book, "Why Romney Lost." Frum was a special assistant to President George W. Bush from 2001 to 2002.

(CNN) -- Good news: We're not going to war in Syria, at least not right away.

Bad news: We're headed to a battle inside Congress that will pose its own grave threat to the U.S. and world economy.

The most conservative Republicans in Congress are threatening to force default on the nation's obligations unless the president agrees to defund Obamacare. Less conservative Republicans prefer a milder version of the threat: not default, but merely shutting down the government.

David Frum
David Frum

Either way, the country plunges into crisis -- a crisis Republicans must eventually lose, as they have lost every previous round of this same game.

It's way past time for Republicans to find a better way. These doomed all-or-nothing battles over Obamacare perversely strengthen President Obama. As Republicans exhaust themselves in grand debates, Obamacare fastens itself ever more tightly upon the country and the states. Obamacare offers large benefits to many Americans, and benefits once extended are very difficult to remove. That should have been the lesson of 2012, and unless Republicans get wiser, it'll be the repeat lesson of 2016.

Meanwhile, the clock is ticking. A core feature of Obama's health plan will go into effect in bare weeks -- and all the law's flaws continue unaddressed. The Republican challenge is to protect the country from those flaws, by concentrating on the reforms that matter most:

1) Control Obamacare's costs;

2) Share Obamacare's burdens more widely.

RNC: We'll run on Obamacare in 2014
Bill Clinton sells Obamacare to public

Take No. 1 first. America used to have two health care cost problems: the cost of the health care system to the total economy, and the cost of health care programs to government budgets. Those two costs were related, but distinct. One example: Before Obamacare, a proposal to raise the Medicare qualification age to 67 would have saved the government money, without changing any real economic costs.

As Obamacare goes into effect, those two costs merge into one. Raise the Medicare age to 67, and Medicare's costs may fall -- but other program costs will rise. An increase in health care costs anywhere will flow directly into an increase in government health care spending. If Republicans want to control the cost of government, they have to change their thinking from "cut government budgets" to "reform health care delivery."

To date, U.S. health care markets have done a poor job of controlling health care costs. That hasn't been a failure Republicans worried much about -- but they had better start, because if markets continue to fail, the alternatives will be ever more voracious health care costs or direct government control.

Now problem No. 2: burden-sharing.

Obamacare purports to finance itself with taxes only on upper-income Americans. The revenues from these taxes will be inadequate just as a matter of arithmetic. Worse, this mode of finance corrodes all political incentive for cost control. Not many voters will deprive themselves of a benefit to save somebody else money.

If Obamacare is to be part of America's future -- which is how the betting must run today -- this program that claims to benefit all should be paid for by all, as Social Security and Medicare are paid for by all.

Back in 2010, Democrats desperate for Republican support would happily have accepted a broader tax mechanism. Today, of course, they have less incentive to deal. Their voters do well out of Obamacare; the costs are borne by those Americans most likely to vote Republican.

But there are revenue measures Democrats would value even more highly than they value taxes on the affluent: carbon taxes, for example. A Republican plan to tax work and investment less and to tax carbon more -- and to use such taxes to support health care costs -- would appeal to Democrats, and would unite both Democrats and Republicans in a shared commitment to health care cost control.

These are real-world political tradeoffs. They are less exciting than the grand drama of repeal-or-bust. But repeal-or-bust is much more likely to produce a bust than a repeal. More productive is the challenge of reforming Obamacare so that the nation can live with its costs -- and so that all equitably shoulder their share of its burdens.

Follow @CNNOpinion on Twitter.

Join us at Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of David Frum.

ADVERTISEMENT
Part of complete coverage on
September 16, 2014 -- Updated 1305 GMT (2105 HKT)
LZ Granderson says Congress has rebuked the NFL on domestic violence issue, but why not a federal judge?
September 16, 2014 -- Updated 1149 GMT (1949 HKT)
Mel Robbins says the only person you can legally hit in the United States is a child. That's wrong.
September 15, 2014 -- Updated 1723 GMT (0123 HKT)
Eric Liu says seeing many friends fight so hard for same-sex marriage rights made him appreciate marriage.
September 15, 2014 -- Updated 1938 GMT (0338 HKT)
SEATTLE, WA - SEPTEMBER 04: NFL commissioner Roger Goodell walks the sidelines prior to the game between the Seattle Seahawks and the Green Bay Packers at CenturyLink Field on September 4, 2014 in Seattle, Washington. (Photo by Otto Greule Jr/Getty Images)
Martha Pease says the NFL commissioner shouldn't be judge and jury on player wrongdoing.
September 16, 2014 -- Updated 1315 GMT (2115 HKT)
It's time for a much needed public reckoning over U.S. use of torture, argues Donald P. Gregg.
September 16, 2014 -- Updated 1225 GMT (2025 HKT)
Peter Bergen says UK officials know the identity of the man who killed U.S. journalists and a British aid worker.
September 16, 2014 -- Updated 1128 GMT (1928 HKT)
Joe Torre and Esta Soler say much has been achieved since a landmark anti-violence law was passed.
September 12, 2014 -- Updated 2055 GMT (0455 HKT)
David Wheeler wonders: If Scotland votes to secede, can America take its place and rejoin England?
September 16, 2014 -- Updated 1241 GMT (2041 HKT)
Jane Stoever: Society must grapple with a culture in which 1 in 3 teen girls and women suffer partner violence.
September 12, 2014 -- Updated 2036 GMT (0436 HKT)
World-famous physicist Stephen Hawking recently said the world as we know it could be obliterated instantaneously. Meg Urry says fear not.
September 12, 2014 -- Updated 2211 GMT (0611 HKT)
Bill Clinton's speech accepting the Democratic nomination for president in 1992 went through 22 drafts. But he always insisted on including a call to service.
September 12, 2014 -- Updated 2218 GMT (0618 HKT)
Joe Amon asks: What turns a few cases of disease into thousands?
September 11, 2014 -- Updated 1721 GMT (0121 HKT)
Sally Kohn says bombing ISIS will worsen instability in Iraq and strengthen radical ideology in terrorist groups.
September 16, 2014 -- Updated 2231 GMT (0631 HKT)
Analysts weigh in on the president's plans for addressing the threat posed by the Islamic State of Iraq and Syria.
September 11, 2014 -- Updated 1327 GMT (2127 HKT)
Artist Prune Nourry's project reinterprets the terracotta warriors in an exhibition about gender preference in China.
September 10, 2014 -- Updated 1336 GMT (2136 HKT)
The Apple Watch is on its way. Jeff Yang asks: Are we ready to embrace wearables technology at last?
ADVERTISEMENT