A Tea Party Health Care Contract with America

A 12-point plan to put patients back in charge—via freedom.

Critics say Obamacare critics “spend all their time opposing the president’s health care reform, but don’t have any alternative, better ideas of their own.” Not true!

I’ve been in Washington health policy circles for two decades. During that time, I’ve seen grassroots conservatives and libertarians generally coalesce around a very robust set of health care reform principles and proposals.

Four years ago, I tried to compile a comprehensive list of them—not just the most popular, but every idea, large and small. I stopped after finding more than 125 distinct ideas, certain I’d probably missed quite a few. Some of the ideas were better than others, but the sheer length of the list proved to me that conservatives and libertarians do in fact have their own alternative ideas for fixing health care. Some Republicans are too topdown for my tastes, favoring a “premium support,” managed-competition approach like RomneyCare. But the majority of Republicans seem to be more favorable to bottom-up, consumer-driven, patient-centered approaches.

Patient-centered care means patients and doctors are in charge instead of politicians and bureaucrats (and that’s regardless of whether the bureaucrats are public or private). It leaves people free to save for their own health care costs and pay their own way as much as possible. Ultimately, people paying directly for their own health care, rather than through third parties, is the only way to get costs down and more people covered without bureaucratic rationing.

For years, I’ve urged Obamacare opponents in Congress to enunciate very clearly what they are “for.” As a grassroots advocate, I’ve advocated our own reform ideas. I’ve now pulled what I regard as the most important ideas into a single, easy-to-understand set of principles.

Here is what I think we should be for:

A Tea Party Health Care Contract with America

  1. Allow everyone to maintain his current health insurance. No exceptions.
  2. Treat everyone the same. No special treatment for Members of Congress, unions, businesses, etc.
  3. Allow people to opt out of federal health insurance benefits, without penalty.
  4. Allow people to own their own medical insurance and take it with them from job to job.
  5. Allow all taxpayers to receive tax deductions for medical expenses, including personal Health Savings Accounts.
  6. Allow insurance companies to compete across state lines. *
  7. Help people with pre-existing medical conditions,  via significant transitional block grants to states rather than mandates.
  8. Encourage doctors and hospitals to provide all citizens advance knowledge of their health care costs (excluding medical emergencies).
  9. Provide reasonable maximums for ‘pain and suffering.’ **
  10. Reduce Medicare expenditures by providing fewer benefits to the wealthy.
  11. Allow the elderly and all doctors the choice between private insurance and Medicare. 
  12. Eliminate first-dollar coverage. Everyone should have some skin in the game.

These twelve principles would inject much-needed “patient power,” choice, and competition into the system.

If people want to have the richest, most expensive health insurance around, why, they should be free to obtain it—with their own money.

If people want bare bones coverage, they should be free to buy that.

If people want no insurance at all — to “go bare” and just rely on their own savings and family and friends — they should be free to do that.

If people want to buy individual rather than group coverage, they should be free to do that.

If seniors want to pay doctors outside of Medicare’s price controls, they should be free to do that.

In other words, people should be free.

I think this plan balances boldness with achievability.

It doesn’t fundamentally change “safety net” programs like Medicare and Medicaid in such a way that the Left can easily mischaracterize the reforms as “harming” people. Instead, it plants seeds of freedom that, if allowed to thrive and grow, will produce improved conditions for reforming the “safety net” programs in the future.

If implemented, this “Health Care Contract” would lower health care costs and improve access to care — and thus reduce the number of uninsured Americans — by voluntary rather than coercive means.

We know this reform plan will work, because we know freedom works.


Dean Clancy, a former senior official in Congress and the White House, writes on U.S. health reform, budget, and constitutional issues. Follow him at deanclancy.com or on twitter @deanclancy.

[Originally published at freedomworks.org, Oct. 17, 2013. @FreedomWorks. Republished at deanclancy.com.]


* By way of interstate compact.

** At the state level.

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