Via this Cato white paper, I submitted the following recommendations to the Department of Government Efficiency, a private-sector organization that will advise President-elect Donald Trump on how to reduce inefficiency in the federal government. The following recommendations would make health care more universal by reducing regulatory barriers to lower-cost, higher-quality health insurance and medical care. I further submitted recommendations relating to federal health spending and the federal tax treatment of health care. The three sets of recommendations operationalize reforms I propose in my latest book, Recovery: A Guide to Reforming the US Health Sector (Cato Institute, 2023).
Individuals have a right to self-medicate, choose their health care providers, and choose whether and how to pool medical expenses with others. When the government respects these rights, health care becomes more universal as a matter of course. Prices fall, owing to market innovation and competition. Quality improves as new treatments and insurance designs make health care better and more secure. The Food and Drug Administration (FDA), the Center for Consumer Information and Insurance Oversight (CCIIO), and other federal and state agencies violate these fundamental human rights.
The results are higher prices and lower quality health care (i.e., less-universal health care). The FDA blocks access to essential medicines and requires patients to get unnecessary prescriptions. Cost–benefit analyses consistently find that, at the margin, FDA regulation on balance harms patient health. The CCIIO enforces regulations that increase insurance premiums and ration care until, as President Biden’s economic adviser Michael Geruso admits, even “currently healthy consumers cannot be adequately insured.” State licensing regulations block patients from accessing top doctors across the country.
The reforms below would cause prices to fall while improving quality—making health care progressively more universal by reducing the number of people who cannot afford the care they need. (The Medicaid/Children’s Health Insurance Program reforms in the Reduce Federal Health Spending section would give states flexibility to address the unmet medical needs that remain.)
The federal government should do the following:
- Abolish the FDA, including its powers to block new medical tests, devices, and treatments from the market; to require patients to obtain prescriptions; and to limit truthful speech.
- Regardless of the fate of the FDA, free patients to purchase medical tests, devices, and treatments that are available in other advanced nations.
- Use the Commerce Clause to free consumers to obtain health services from clinicians who hold licenses in other states and US territories.
- Use the Commerce Clause to free consumers and employers to purchase health insurance from other states and US territories.
- Repeal what’s left of the Patient Protection and Affordable Care Act of 2010 (i.e., Obamacare) and other federal laws that restrict health insurance choice.
- Free consumers and employers to purchase health insurance exempt from federal regulations, by
- creating a new category of statutorily exempt health insurance;
- codifying President Trump’s 2018 rule regarding “short-term” health plans; and
- codifying President Obama’s 2014 guidance exempting US territories from Obamacare regulations (and then freeing consumers and employers to purchase insurance from US territories).