To its critics, Republicans’ Obamacare replacement bill is not just a bad idea, it seems to reveal a dearth of ideas. The impression among some liberals (and even conservatives) is that, given seven years to come up with an alternative to Obamacare, the best the GOP could do was to water down the Affordable Care Act and throw in some personal-responsibility measures for flair.
But in fact, some hardcore conservatives do have pretty radical health-care ideas—they’re just not anything like the American Health Care Act. Over the course of several recent interviews, the Heritage Foundation’s Ed Haislmaier shared his vision for a fully market-based health system, in which people subscribe to their doctors like they would Netflix and low-performing general hospitals get crushed by scrappy, stand-alone specialty practices. Access to doctors and treatments would hinge on whatever the “the market” deemed best, with consumers the kingmakers.
His ideas probably won’t resonate with those who fear that vulnerable populations will slip through the cracks, but they are a stark departure from the typical Republican talking points on health care—like, say, selling insurance across state lines.
Haislmaier, the foundation’s senior research fellow for health policy, is influential in Republican circles: He worked on the Trump administration’s transition team, primarily on ways to stabilize the Obamacare marketplaces. He’s now back at Heritage full time. Like Heritage Action, the think-tank’s political arm, Haislmaier doesn’t like the AHCA, saying it doesn’t “undo a lot of what’s really wrong with the Affordable Care Act.” Most of his ideas would rise from the ashes of a long-gone ACA, or be rolled out gradually by enterprising states and cities.