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 30, 2014 -- Updated 1326 GMT (2126 HKT)
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, writes William Piekos.
September 27, 2014 -- Updated 2209 GMT (0609 HKT)
As Prime Minister Narendra Modi visits America, Madeleine Albright says a world roiled by conflict needs these two great democracies to commit to moving their partnership forward
September 29, 2014 -- Updated 1802 GMT (0202 HKT)
John Sutter: Lake Providence, Louisiana, is the parish seat of the "most unequal place in America." And until somewhat recently, the poor side of town was invisible on Google Street View.
September 29, 2014 -- Updated 1311 GMT (2111 HKT)
Julian Zelizer says in the run up to the 2016 election the party faces divisions on its approach to the U.S.'s place in the world
September 29, 2014 -- Updated 1419 GMT (2219 HKT)
Ruben Navarrette says Common Core supporters can't devise a new set of standards and then fail to effectively sell it.
September 30, 2014 -- Updated 1329 GMT (2129 HKT)
Earlier this month, Kenyans commemorated the heinous attack on the Westgate Mall in Nairobi.
September 29, 2014 -- Updated 2057 GMT (0457 HKT)
David Wheeler says Colorado students are right to protest curriculum changes that downplays civil disobedience.
September 27, 2014 -- Updated 0158 GMT (0958 HKT)
Sally Kohn says when people click on hacked celebrity photos or ISIS videos, they are encouraging the bad guys.
September 26, 2014 -- Updated 1155 GMT (1955 HKT)
Loren Bunche says she walked by a homeless man every day and felt bad about it -- until one day she paused to get to know him
September 30, 2014 -- Updated 1332 GMT (2132 HKT)
ISIS grabs headlines on social media, but hateful speech is no match for moderate voices, says Nadia Oweidat.
September 29, 2014 -- Updated 1233 GMT (2033 HKT)
A new report counts jihadists fighting globally. The verdict? The threat isn't that big, says Peter Bergen.
September 23, 2014 -- Updated 2137 GMT (0537 HKT)
Ebola could become the biggest humanitarian disaster in a generation, writes former British Prime Minister Tony Blair
September 26, 2014 -- Updated 1658 GMT (0058 HKT)
ISIS has shocked the world. But will releasing videos of executions backfire? Four experts give their take.
September 26, 2014 -- Updated 1439 GMT (2239 HKT)
Eric Holder kicked off his stormy tenure as attorney general with a challenge to the public that set tone for six turbulent years as top law-enforcement officer.
September 26, 2014 -- Updated 1309 GMT (2109 HKT)
LZ Granderson says Obama was elected as a war-ending change agent, not a leader who would leave behind for his successor new engagement in Iraq and Syria. Is he as disappointed as the rest of us?
September 24, 2014 -- Updated 0910 GMT (1710 HKT)
Gayle Lemmon says the question now is how to translate all the high-profile feminizing into real gains for women
September 25, 2014 -- Updated 1900 GMT (0300 HKT)
John Sutter says the right is often stereotyped on climate change. But with 97% of climate scientists say humans are causing global warming, we all have to get together on this.
September 25, 2014 -- Updated 1257 GMT (2057 HKT)
Andrew Liepman and Philip Mudd: When we declare that we will defeat ISIS, what do we exactly mean?
September 26, 2014 -- Updated 2040 GMT (0440 HKT)
Thailand sex trafficking
Human trafficking is a multibillion dollar global industry. To beat it, we need to change mindsets, Cindy McCain says.
September 26, 2014 -- Updated 2242 GMT (0642 HKT)
The leaders of the GOP conferences say a Republican-led Senate could help solve America's problems.
September 25, 2014 -- Updated 1401 GMT (2201 HKT)
Nicholas Syrett says Wesleyan University's decision to make fraternities admit women will help curb rape culture.
September 25, 2014 -- Updated 1302 GMT (2102 HKT)
Mike Downey says New Yorkers may be overdoing it, but baseball will really miss Derek Jeter
September 29, 2014 -- Updated 1232 GMT (2032 HKT)
Quick: Which U.S. president has authorized wars of various kinds in seven Muslim countries?
September 24, 2014 -- Updated 1817 GMT (0217 HKT)
Women's issues should be considered front and center when assessing a society's path, says Zainab Salbi
September 23, 2014 -- Updated 1805 GMT (0205 HKT)
A catastrophe not making headlines like Ebola and ISIS: the astounding rate of child poverty in the world's richest country.
ADVERTISEMENT