“Small Bill” could be GOP answer to Obamacare

(Centennial Fellow) In the battle over health care the Democrats’ great advantage was successfully identifying themselves with the plight of thirty three million uninsured Americans. When Republicans advanced their own plan to the Congressional Budget Office it was shown to extend coverage to a mere three million people. For the remainder of the debate the Democrats-greatly aided by the media- used this disparity as a stick to relentlessly beat Republicans for their “callous indifference” to the uninsured.

Though current polling is highly favorable to Republicans as we move closer to the November elections it will not be enough to campaign solely on repeal of Obamacare. It is imperative for Republicans to identify and rally around a credible alternative that persuasively addresses the very real problems of health care in America. In doing so they must decisively take the issue of the uninsured away from the Democrats and make it their own trump card.

Recently just such a credible alternative has emerged and it is highly impressive. It is called the “Small Bill”, and it is the brainchild of Jeffrey Anderson, the Director of the Benjamin Rush Society which is an organization of medical professionals who advocate a free health care market.

At the outset the Small Bill demonstrates that the “fact” of 33 million uninsured American citizens is a myth, albeit a myth that the Democrats successfully used as a battering ram to pass Obamacare.

How did this happen?

Throughout a year of public debate many estimates of the number of uninsured were bandied about-commonly anywhere from thirty to fifty million. At some point the Democrats and an uncritical media fastened on the number 33 million, and Republicans made little effort to contest it.

Another number-rarely mentioned- was total U.S. population, currently estimated by the U.S. Census Bureau at 309 million people. The juxtaposition of the numbers 33 and 309 is important because it offers perspective on the dimensions of “The Problem”. Whether a problem is “huge and overwhelming” or “serious but manageable” goes far toward shaping appropriate legislation.

Even accepting the 33 million figure, that is barely 11 percent of total population, a number which must be contrasted with the 85% (according to most polls) of Americans who were basically satisfied with their existing healthcare programs.

The perspectives offered by such contrasts and comparisons and their policy implications were never seriously spotlighted in the public debate. Neither was much attention given to analysis of who the uninsured were, and why they lacked coverage.

Opponents of Obamacare missed an important opportunity when they failed to drill down on these numbers, because fairly authoritative data was available from the U.S. Census Bureau which reports that there are actually 28 million uninsured Americans: 46 million uninsured people living in the United States, less 9 million non-citizens, and less 9 million people on Medicaid who the Census reports were mistakenly listed as uninsured. Unfortunately CBO estimates count the 18 million non-citizens and Medicaid recipients as uninsured.

The Census further tells us that not all of the remaining 28 million lack insurance because they are poor since about half of them earn more than the median U.S. income. These 14 million-presumptively younger and / or healthier people- have as is their right simply chosen not to buy health coverage.

Thus in the end we are left with 14 million people- just 4.5 percent of total U.S. population- who are uninsured and relatively low income.

By right these figures should have propelled Congress away from the “huge and overwhelming” perception toward the “serious but manageable perception”. Unfortunately for the country, it didn’t.

Unlike the Democrats’ 2,700 page bill, the Small Bill can be summarized on a single page, hence the name. It offers seven very specific solutions to controlling health care costs and covering the uninsured. They are:

1. Serious tort reform; 2. allowing insurance purchase across state lines; 3. allowing lower premiums for healthier lifestyles; 4. giving the uninsured and self-insured the same tax breaks as people with employer provided programs; 5. increasing federal support for state-run high risk pools; 6. getting the uninsured out of Emergency Rooms and into less expensive routine care; and 7. implementing a few regulatory and Administrative reforms included in the House Republicans health care proposal.

Further details are available at www.smallbill.org or in Jeffrey Anderson’s excellent National Review article (April 19, 2010). The following contrasts between the Small Bill and Obamacare should more than justify that closer look:

Cost Obamacare – 2.5 trillion; Small Bill- 180 billion

Taxes Obamacare – 1 trillion dollars; Small Bill- zero

Medicare Advantage cuts Obamacare – 254 billion; Small Bill- zero

Insurance Premiuns Obamacare – 10-13 % increase; Small Bill- 5-8 % decrease

10 year cost Obamacare – 76,000 dollars; Small Bill- 18,000 dollars
per newly insured person

Deficit Spending 2015-19 Obamacare – 139 billion dollars; Small Bill- deficit neutral
(CBO estimates)

If this cost comparison was clearly and persuasively presented to American voters, which plan do you think they would prefer? Let Jeffrey Anderson have the last word: “Lower insurance premiums instead of higher, no trillion dollar tax hike, no hundreds of billions of dollars in Medicare cuts- and all at 7 percent of the cost of the Democrats’ program. If the Small Bill sounds too good to be true, that illustrates how colossally bad Obamacare is”.

Absent a better idea, Republicans should validate, refine, and rally around this proposal as a centerpiece of their Fall campaign strategy. Done right the Small Bill could be a key engine driving a massive Republican victory in the most important mid-term elections of our lifetime.


William Moloney’s columns have appeared in the Wall St Journal, USA Today, Washington Post, Washington Times, Denver Post, Rocky Mountain News, and Human Events.

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