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
August 22, 2014 -- Updated 2145 GMT (0545 HKT)
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
August 22, 2014 -- Updated 1231 GMT (2031 HKT)
James Dawes says calling ISIS evil over and over again could very well make it harder to stop them.
August 23, 2014 -- Updated 1617 GMT (0017 HKT)
John Bare says the Ice Bucket Challenge signals a new kind of activism and peer-to-peer fund-raising.
August 22, 2014 -- Updated 2231 GMT (0631 HKT)
As the inquiry into the shooting of Michael Brown continues, critics question the prosecutor's impartiality.
August 22, 2014 -- Updated 2247 GMT (0647 HKT)
Newt Gingrich says it's troubling that a vicious group like ISIS can recruit so many young men from Britain.
August 22, 2014 -- Updated 1223 GMT (2023 HKT)
Retired Lt. Gen. Mark Hertling says he learned that the territory ISIS wants to control is amazingly complex.
August 21, 2014 -- Updated 1450 GMT (2250 HKT)
David Weinberger says Twitter and other social networks have been vested with a responsibility, and a trust, they did not ask for.
August 22, 2014 -- Updated 1103 GMT (1903 HKT)
John Inazu says the slogan "We are Ferguson" is meant to express empathy and solidarity. It's not true: Not all of us live in those circumstances. But we all made them.
August 20, 2014 -- Updated 1951 GMT (0351 HKT)
Cerue Garlo says Liberia is desperate for help amid a Ebola outbreak that has touched every aspect of life.
August 21, 2014 -- Updated 1742 GMT (0142 HKT)
Eric Liu says Republicans who want to restrict voting may win now, but the party will suffer in the long term.
August 21, 2014 -- Updated 1538 GMT (2338 HKT)
Jay Parini: Jesus, Pope and now researchers agree: Wealth decreases our ability to sympathize with the poor.
August 21, 2014 -- Updated 1200 GMT (2000 HKT)
Judy Melinek offers a medical examiner's perspective on what happens when police kill people like Michael Brown.
August 19, 2014 -- Updated 2203 GMT (0603 HKT)
It used to be billy clubs, fire hoses and snarling German shepherds. Now it's armored personnel carriers and flash-bang grenades, writes Kara Dansky.
August 20, 2014 -- Updated 1727 GMT (0127 HKT)
Maria Haberfeld: People who are unfamiliar with police work can reasonably ask, why was an unarmed man shot so many times, and why was deadly force used at all?
August 18, 2014 -- Updated 2152 GMT (0552 HKT)
Ruben Navarrette notes that this fall, minority students will outnumber white students at America's public schools.
August 19, 2014 -- Updated 2121 GMT (0521 HKT)
Humans have driven to extinction four marine mammal species in modern times. As you read this, we are on the brink of losing the fifth, write three experts.
August 18, 2014 -- Updated 2006 GMT (0406 HKT)
Pepper Schwartz asks why young women are so entranced with Kardashian, who's putting together a 352-page book of selfies
ADVERTISEMENT