Skip to main content

The real problems with Obamacare

By David Frum, CNN Contributor
updated 6:48 AM EDT, Tue September 17, 2013
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
updated 12:41 PM EDT, Wed April 23, 2014
Robert Hickey says most new housing development is high-end, catering to high-earners.
updated 9:17 AM EDT, Wed April 23, 2014
Alexander Motyl says as Russian President Putin snarled at Ukraine, his foreign minister was signing a conciliatory accord with the West. Whatever the game, the accord is a major stand down by Russia
updated 8:29 AM EDT, Wed April 23, 2014
Les Abend says at every turn, the stowaway teen defied the odds of discovery and survival. What pilot would have thought to look for a person in the wheel well?
updated 6:47 PM EDT, Tue April 22, 2014
Q & A with artist Rachel Sussman on her new book of photographs, "The Oldest Living Things in the World."
updated 3:58 PM EDT, Tue April 22, 2014
Martin Blaser says the overuse of antibiotics threatens to deplete our bodies of "good" microbes, leaving us vulnerable to an unstoppable plague--an "antibiotic winter"
updated 1:37 PM EDT, Tue April 22, 2014
John Sutter asks: Is it possible to eat meat in modern-day America and consider yourself an environmentalist without being a hypocrite?
updated 11:38 AM EDT, Tue April 22, 2014
Sally Kohn notes that Meb Keflezighi rightly was called an American after he won the Boston Marathon, but his status in the U.S. once was questioned
updated 8:56 AM EDT, Tue April 22, 2014
Denis Hayes and Scott Denman say on this Earth Day, the dawn of the Solar Age is already upon us and the Atomic Age of nuclear power is in decline
updated 4:36 PM EDT, Mon April 21, 2014
Retired Coast Guard officer James Loy says a ship captain bears huge responsibility.
updated 1:08 PM EDT, Mon April 21, 2014
Peter Bergen says the latest strikes are part of an aggressive U.S. effort to target militants, including a bomb maker
updated 9:45 AM EDT, Mon April 21, 2014
Cynthia Lummis and Peter Welch say 16 agencies carry out national intelligence, and their budgets are top secret. We need to know how they are spending our money.
updated 8:35 AM EDT, Mon April 21, 2014
Julian Zelizer says President Obama knows more than anyone that he has much at stake in the midterm elections.
updated 8:55 AM EDT, Tue April 22, 2014
Eric Sanderson says if you really want to strike a blow for the environment--and your health--this Earth Day, work to get cars out of cities and create transportation alternatives
updated 10:08 AM EDT, Mon April 21, 2014
Bruce Barcott looks at the dramatic differences in marijuana laws in Colorado and Louisiana
updated 4:47 PM EDT, Fri April 18, 2014
Jim Bell says NASA's latest discovery supports the notion that habitable worlds are probably common in the galaxy.
updated 2:17 PM EDT, Fri April 18, 2014
Jay Parini says even the Gospels skip the actual Resurrection and are sketchy on the appearances that followed.
updated 1:52 PM EDT, Fri April 18, 2014
Graham Allison says if an unchecked and emboldened Russia foments conflict in a nation like Latvia, a NATO member, the West would have to defend it.
updated 9:11 AM EDT, Fri April 18, 2014
John Sutter: Bad news, guys -- the pangolin we adopted is missing.
updated 2:25 PM EDT, Mon April 21, 2014
Ben Wildavsky says we need a better way to determine whether colleges are turning out graduates with superior education and abilities.
updated 6:26 AM EDT, Fri April 18, 2014
Charles Maclin, program manager working on the search and recovery of Malaysia Flight 370, explains how it works.
updated 8:50 AM EDT, Fri April 18, 2014
Jill Koyama says Michael Bloomberg is right to tackle gun violence, but we need to go beyond piecemeal state legislation.
updated 2:45 PM EDT, Thu April 17, 2014
Michael Bloomberg and Shannon Watts say Americans are ready for sensible gun laws, but politicians are cowed by the NRA. Everytown for Gun Safety will prove the NRA is not that powerful.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT