There hasnt been any agreement on any single proposal. But that may be about to change. A combination of the republican takeover of the senate, a looming Supreme Court decision and the white house race are putting more pressure than ever before on republicans to offer some sort of alternative to obamacare. But before they could get to any sort of agreement, there are some fundamental philosophical disagreements that need to be worked out about how to get and move the country into a more free market direction. And thats why i wrote my book, overcoming obamacare. And what i tried to do is i looked at the flurry of plans that have been offered as alternatives to obamacare. And i sorted them into three basic approaches or schools of thought. The first school of thought i called Reform School and this is comprised of people who say that at this point it might be unrealistic to fully repeal obamacare. And holding out for full repeal shouldnt be a barrier to instituting reforms to the overall system that will move things in a more marketoriented direction. The second approach i describe as the replace school and this is comprised of people who think that obamacare does, in fact, need to be repealed but that it can only be done that way if opponents offer a credible alternative that in some way grapples with the changes that obamacare have made and the beneficiaries that its created. The last but not least is what i call the restart school, and this is comprised of people who think that obamacare needs to be repealed and fully wiped off the books and that the only way that you can create a true free market alternative is from starting from scratch and focusing on lowering costs rather than just figuring out a way to expand coverage. So were fortunate today to be joined with three very forceful advocates for these various approaches. I want to start with iowa Vick Roy Avik roy of the Manhattan Institute whos authored his own plan as an alternative to obamacare, and he also was recently named as a policy adviser to rick perry. Next we have Jeff Anderson whos the director of the 2017 project, and he is also he has also authored an obamacare alternative thats very close to some of the plans that have been offered on capitol hill with some changes that we can talk about. And michael cannon of the Cato Institute has been described as obamacares singlemost relentless antagonist. And hes gained notoriety recently as one of intellectual architects of the Supreme Court challenge to obamacares federal Insurance Exchange subsidies. So i wanted to start with a philosophical question. Avik, youve written that universal coverage is a morally worthy goal. Michael, youve been the author of what youve called the antiuniversal Coverage Club manifesto. So i just want to get you two to fight about this. So avik, why dont you start and explain why you think from a free market perspective that it should be the governments role to provide universal coverage. Well, i would put it slightly differently. I would put it this way for example, we never say we would never well what you hear people like michael cannon, not necessarily michael cannon a number of people say it, we can never outbid the left on covering people with Health Insurance. So we shouldnt try to outbid them, we should just do something thats kind of politically acceptable in the middle somewhere. But we would never say that about, say smartphones. We would never say free markets cant outbid the government on the ability for every american to have a smartphone. We wouldnt say free markets cant outbid the government on giving People Better jobs and more Economic Growth. So why is it that we accept the progressive premise that the only way to expand access to High Quality Health Care is through government . I would argue actually, that you can expand access to health care for more people at a lower cost through free markets than through government. However, the goal of expanding access to coverage and care is a noble and appropriate one, and one thing i think we get so trapped in is we live in this progressive debate where its all about what the government can do and cant do. We dont actually embrace the policy goal of expanding access to care and coverage which is something free markets can achieve better than the government, and thats what we should be striving to do. Michael, what would you say . I see it as my role here to exaggerator the differences between avik and me, and let me try to do that. Of course, we can outbid the left when it comes to making Health Care Better and more affordable and bringing it within the reach of more poor people and thats what we should be doing. That should be our goal. The problem is that expanding coverage, if you make that your proxy for that goal, it actually interferes with the goal of better more affordable coverage for everybody. Because at a certain point as even Kenneth Arrow acknowledged, nobel prizewinning economist wrote a seminal argument on uncertainty in the world of economics and medical care that everyone justifies whatever Government Intervention they want in market. Even Kenneth Arrow acknowledged that insurance is pointless in certain situations because the costs exceed the benefits. And when i say and people like me say that we cant outbid the left when it comes to covering people with Health Insurance its because the left can always say, well, well have a singlepayer system, the governments going to cover everyone. Whereas if were going to use market principles and let individuals make their choices, after a certain point people are going to buy not as much coverage or at a certain point, some people are not going to buy any coverage at all. Thats actually important. Thats not only healthy thats crucial for the operation of a high performing Health Insurance market and health care market. But were never going to get to universal coverage if we just allow people to make their own choices. And to get there and we make expanding coverage or universal coverage our goal, then the left will always be able to say youre a failure because you havent delivered on universal coverage. And then advocate interventionings that make d interventions that make health care worse and more expensive. Thats why we shouldnt even concede the goal of universal coverage or even the government should be expanding coverage because it frustrates which is really our shared goal of making Health Care Better and more affordable and more secure. Two points in response to that. First, theres again, no reason we should accept the lefts definition of the terms. The traditional understanding of insurance, Car Insurance or Homeowners Insurance you get Car Insurance so that if you crash your car youre protected from catastrophic financial loss. Thats what Health Insurance should be. The fact that the left distorts the meaning of the word insurance to mean, actually, prepayment for all Health Care Services doesnt mean we should simply accept that. We should say, yes its a noble goal for every american to have the ability to afford true Health Insurance that protects them from bankruptcy due to injure or illness. Thats a noble policy goal, and free markets can achieve it. Youre making it easy for me to exaggerate our differences. Another criticism i have of the law the way a lot of conservatives approach health care and Health Care Reform is this idea that theyre trying to sell the public that insurance should only be for catastrophic illnesses, that if you buy a health plan, it should have a 5,000 deductible and cover nothing else below the deductible. I think the conservatives lose a lot of people when they talk like that, because a lot of people are very riskaverse, so they might want they should be free to buy it. They should be free to buy it, and theres also a lot of value that health plans can provide below that 5,000 deductible. Finding out what interventions what sort of Preventive Care is Cost Effective and maybe covering that with no copayments so that diabetics who maintain, take care of their illness and so they dont end up with complications later on. I think that its very important that we not try to offer for people any definition of what insurance should be. We should leave that to individual consumers as well. I think this is another way that conservatives get themselves in trouble on health care. Now jeff, what do you think . Do you think it should be a goal of conservatives to try to move toward universal coverage . I certainly dont think its the governments duty or obligation to provide universal coverage. Its a free country, and if people are allowed to live freely, then theyre not all going to choose to have Health Insurance. But i think its also a worthy goal to make it as possible as it can be, lowering costs having a vibrant market where people can actually choose to buy coverage if they want. I think as a practical matter in the obamacare debate if we want to repeal obamacare we do have to offer an alternative that focuses on both costs and coverage as a political reality. And i would fall somewhere in between, i think, of the two gentlemen on either side of me. I would agree, i dont think theres any need to outperform liberals on estimates of the number of people who would be covered under an obamacare alternative, but i think you have to at least make a good faith effort. You cant afford to just get absolutely clobber inside that vein if you want to clobbered in that reign if you want to win pretty d in that vein if you want to win politically. I think what jeff and michael talked about is when it comes to repealing obamacare. Now, youve released a plan that youve argued is fully compatible with repealing obamacare, but that it could be implemented without the need to repeal obamacare. But thats put you at odds with a lot of people on this issue. So why did you make that decision . Yeah. So i think just to be clear about what the plan does the plan can repeal obamacare and replace it with the replacement approach or you can get to the same end result by repealing large chunks of obamacare but then taking whats remaining and changing it to end up in the same place. And the reason why that option is important is because any replacement plan that we as republicans or conservatives propose has to get through the United States senate. And we dont have 60 votes in the United States senate. And so, and this is something that we dont talk about at all in the obamacare debate at all. But the fact is unless we have 60 vote, and even if you did have 60 votes not all 60 republicans are going to agree with each other on everything. So its not so easy. They lost the public option because Joe Lieberman and ben nelson said no to the public option and people like howard dean had meltdown cans on msnbc saying we should burn down obamacare because it doesnt have a public option right . So we dont have 60 votes. And so if we dont have 60 votes and were going to have to pick off, say six right now the republicans have 54 votes. Lets assume they maintain that majority in 2017 which is no small thing but if republicans are lucky enough, theyre still going to have to find six democrats to go along with whatever they want to do to replace obamacare. And i think its going to be hard to find democrats who support repealing every single word of obamacare. I do, however think there is support for a marketo credibilitied plan. So given those political realities, why were you for repeal in 2012 . Because the subsidies hadnt get come into play. I think a lot of us felt in 2010 2011, 2012 that if we could repeal obamacare fully before obamacare went into place, then we would have a lot more options. How would you do that with nowhere near 60 votes in the senate . Theres a difference between replacing obamacare and repealing it, right . So there was a lot of evidence to believe that we could repeal obamacare, just repeal alone through reconciliation which requires only 51 votes. However, replacing obamacare cant be done through reconciliation. You have to because of all the regulatory changes you have to make the reconciliation process for those who dont know is the budgetary process that allows you to make certain changes to the law that have to do with the budget. They have to have a Material Impact on revenues or spending. The challenge with health care is big chunks of it have to do with revenue and spending, but big chunks of it have to do with regulation how you regulate insurance, preexisting conditions, things like that. So a replacement plan, because it has to do with regulatory changes, not justifies call changes, does require not just fiscal changes, does require 60 votes. You can probably repeal obamacare with reconciliation with only 50 or 51 votes but you wont be able to replace it, and i think we all i guess i dont see where thats changed n. 2012 you could buy your own i think its right repeal obamacare using reconciliation. You can still do it in 2017, i should say 2013, 2017. In either case youre going to need 60 votes to get a full replacement package although you could get, certainly, large portions of that through reconciliation. So i dont really see what has changed. And the reality is that in pram pas second president obamas second term there have been 181 polls taken on obamacare according to real clear politics, and all 118 have shown it to be unpopular. So to give up on repeal at point seems to me to be politically totally unnecessary and at the same time rather fatalistic if you believe as i do, that repealing obamacares the most important thing that we can possibly do in the political realm. Thats a misrepresentation of my view. I still support the repeal of obamacare. I just think that we have to make sure that whatever we propose can get 60 votes in the senate. And so if we can get 60 votes in the senate for repealing obamacare and replacing it with what i propose great. If we have to do Something Different but we get to the same end result, great. I mean, but your plan keeps a lot of elements of obamacare. You have the preexisting condition ban, you have a lot of the Insurance Regulations not as strip gent as obamacare. Stringent as obamacare. You have the tax credits. They dont quite, arent quite as generous as obamacare. But even the sort of replacement, if you want to call it, is sort of still has a lot of elements. Well, i think if youre arguing that any plan that attempts to offer tax credits to the uninsured is somehow obamacare like, then there are probably a half dozen to nine different plans that republicans would propose including jeff, that are obamacarelike. I would contend that republicans in service for a long, long time have said that the best way to reform the Health Care System is to let patients control the dollars and not the government. Let people buy whether its Health Insurance or hsas or generous Health Insurance plans or catastrophic plans large hsas as michael has advocated in the past, let people have those options and let people buy plans that make sense for them. And the question is not the end result, which we all share but its how you get there. And, again with any replace plan requiring 60 votes in the senate, we have to at least be intellectually prepared for the possibility that we cant do exactly what we do if republicans controlled 60 votes in the senate. So all i tried to do with transcending obamacare is say here are some options. We can do it the repeal and replace way. We can do it by mite grating to migrating to this new system, but having a lot of different ways to get there so we can put together the legislative majority to get it done. Yeah. I think what youre hinting at phil theres a colossal difference between keeping the architecture of obamacare. It took 2700 pages to lay this architecture out. I mean, keeping it and just trying to rearrange it some or scrapping it and starting over is a huge, huge difference. And i think that youre glossing over that a little bit i think youre misrepresenting, misrepresenting the plan. The plan doesnt do that. Because you have called a lot of these plans obamacarelike. So i wanted to get your thoughts on this. So republicans conservatives and notice i say republicans conservatives and i dont say we because im not a republican, and im not a conservative. But republicans and conservatives have gotten themself in a lot of trouble over health care in the past because the right doesnt spend as much time and energy on health care as the left does. And so they have, theyve fallen for ideas like an individual mandate. Because they didnt think these things through enough and realize that wait a second, an individual mandate used as a coercive power of government to provide people with Health Insurance the same way a singlepayer system does, so theyre really two different, theyre two degrees of the same animal. So they ended up endorsing that back in the early 90s and then 20 years later we ended up with that, with 60 votes for that in congress because republicans werent following their principles and thinking closely enough about these things. I think the same thing is happening right now when it comes to Health Insurance tax credits. I do call them obamacarelike. Its because they involve a lot of redistribution, like obamacare does. Its because they function exactly like an individual mandate where either you buy a governmentdefined Health Insurance plan and pay less money to the gover