I wanted to start with a philosophical question. You have written that universal coverage is the morally worthy goal, michael, you were the author of what you call the anti universal coverage manifesto. I want to get you to fight about this. Why dont you start and explain why you think from a freemarket perspective it should be the governments rolled to provide universal coverage . I would put it slightly differently. I would put it this way. We never say when you hear people like michael cannanore a number of people say we can never outbid the left on covering people with Health Insurance we should try to outbid them but do something that is not publicly accessible in the middle somewhere. We would never say that about smart phones we would never say freemarket cant outbid the government on the ability of every american to have a smart phone. We would save 3 markets cant outbid the government on giving People Better jobs and more Economic Growth. Why is it we accept the progressive premise that the only way to expand access to highquality health care is through government . I would argue you can expand health care for more people at lower cost through free market than through government. However the goal of expanding access to coverage and care is the noble and appropriate one and one thing we get trapped in is we live in this progressive debate where it is all about what the government can do and cant do. We dont embrace the policy goal the policy goal of expanding access to care and coverage is something freemarket can achieve better and the government and that is what we should be striving to do. What would you say . My role exaggerates the differences, let me try to do this. Of course we can outbid the left when it comes to making Health Care Better and more affordable. Within the reach of more poor people. That should be our goal. The problem is expanding coverage, if you make that or proxy it interferes with the goal of better more affordable Higher Quality coverage for everybody. At a certain point, as Ken Jeff Atwater will let knowledge nobel prizewinning article on uncertainty in the welfare of medical care that everyone sites whenever Government Intervention they want in markets, acknowledge that insurance is pointless incidents situations because the cost exceeds the benefits. And when i say it people like me say we care about when it comes to covering people with Health Insurance is because the left can always have a single payer system and have the Government Cover everyone. Whereas if we are going to Produce Market principles individuals make those choices after is in point people will buy known as much coverage or address in point not as much coverage as the government wants or not any coverage at all. That is important, not only healthy but crucial for the operation of a high performing healthinsurance market and Health Care Market but we are never going to get universal coverage if we just allow people to make their own choices. To get there it will make expanding coverage or universal coverage our goal the left will always say you are a failure because you havent delivered universal coverage. That is why advocate interventions that make health care worse and more expensive and take it out of peoples reach. That is why we shouldnt even concede the goal of universal coverage or the government should be expanding coverage because it frustrates what is really our shared goal of making Health Care Better and more affordable and more secure. Two points in response there is no reason we should set the lefts definition of the terms. Traditional understanding of what insurance is when we think of Car Insurance or Homeowners Insurance you get Car Insurance if you crash your car you are protected from catastrophic financial loss. The fact that the left and distorts the meaning of the word insurance to mean prepayment for all Health Care Services doesnt mean we should simply accept that. Is a noble goal for every american to have the ability to of forbes through Health Insurance that protects them from bankruptcy due to injury or illness. That is a noble policy goal of free markets can achieve. Youre making it easy for me to exaggerate our differences. Heres another way. Another criticism i have of the law l. A. Law of conservatives approach health care and Health Care Reform is the idea that they are trying to sell the public that insurance should only be for catastrophic illnesses. If you buy a health plan is to have a 5,000 deductible and cover nothing else, conservatives lose a lot of people when they talk like that because people are very risk averse and wants more coverage than that and should be free to buy it and there is a lot of value that health plans can provide below the 5,000 deductible especially the medical literature finding out what intervention, what Preventive Care is Cost Effective and covering that with no copay. And take care of their illness so they dont end up with complications later on. It is important that we not try to offer for people any definition of what insurance should be. We should leave that individual consumers as well. This is another way conservatives get in trouble on health care. What do you think . Should it be a goal of conservatives to try to move toward universal coverage . I dont think it is the governments do your obligation to provide universal coverage. It is a free country and people are allowed to live freely they are not all going to choose to have Health Insurance but it is also a worthy goal to make it possible as it can be, lowering costs having a vibrant market where people can choose the coverage they want. As a practical matter in the obamacare debate if we want to repeal obamacare we have to offer an alternative that focuses on cost and coverage as a political reality and somewhere in between two gentlemen on either side of me, i would agree i dont think there is any need to outperform liberals on estimates of the number of people who would be covered under an obamacare alternative but you have to make a goodfaith effort, you cant afford to just casually get clobbered if you want to win politically. I think one area where that planned to chris from we talked about and repealing obamacare. And fully compatible with obamacare, and implemented without the need to repeal obamacare and put you at odds with a lot of people on this issue, so why did you make that decision . To be clear what the plan does, the plan can repeal obamacare with replacement approach and the same end results of repealing large chunks of obamacare that taking what is remaining and changing it to end up in the same place. The reason that option is important is any replacement plans we as republicans or conservatives propose has to get through the senate and you dont have 60 votes in the United States senate. What we dont talk about all in the obamacare debate but the fact is unless we have 60 votes and even if you did, not all 16 republicans will agree with each other so getting 60 votes as democrats demonstrated is not so easy. They lost the public option because Joe Lieberman and ben nelson said no to the public option. People like howard dean had meltdowns on m snbc saying we should burn down obama care because it doesnt have a public option. We dont have 60 votes. If we dont have 60 votes and if we have to pick off six republicans at 54 votes, lets assume the majority is maintained in 2017 which is no small thing because they have a lot of stuff up for grabs in the next election but if republicans are lucky enough to have 60 more votes in 2017 they have to find six democrats to go along with whatever they want to do to replace obamacare and it will be hard to find democrats whose support revealing every word of obamacare. I do think however there is bipartisan support for market warranted plant that achieved policy goal of making it more accessible to more people. Why we for repeal in 2012 . The subsidies had not yet coming to play. In 201020112012, if we could repeal obamacarefully, before it went into place, then we would have a lot more options. How would you do that with no where near 60 votes . Theres a difference between replacing and appealing obamacare. A lot of us believed we could repeal obamacare, just repeal all loans through reconciliation which requires only 51 votes. Replacing obamacare cant be done through reconciliation. Because of regulatory changes you have to make the reconciliation, a budgetary process allows certain changes to the law that have to do with the budget and revenue and spending. The challenge with health care is chunks of it had to do with revenue spending and regulating insurance or preexisting conditions and things like that. Replacement plan because it has to do with regulatory changes does require 60 votes. That is why obamacare was passed with 60 votes in the senate so you can probably, we dont know for a fact that you can probably repeal obamacare with reconciliation with only 50 or 51 votes but you wont be able to replace it and that king we are all agreed you got to replace it. I dont see where that has changed. In 2012 by your own reasoning, you could regular obamacare using reconciliation you could still do it in 2017 in either case you will need 60 votes to get a full replacement package, large portions of that reconciliation, and what has changed and the reality is president obamas second term there have been 181 polls taken on obamacare according to real clear politics and all 180 one have shown it to be unpopular. To give up on repeal at this point seems to me to be politically totally unnecessary and at the same time rather fatalistic view believe as i do that repealing obamacare is the most important thing we could possibly do in the political realm. That misrepresentation, i still support the repeal of obamacare but i think we have to make sure that whatever we propose can get 60 votes in the senate and if we get 60 vote in the senate for replacing it with what i propose, great. If we have to do Something Different but it to the same end result great. Your plan keeps a lot of elements of obamacare. You have a lot of insurance regulation not as stringent as obamacare. You have the tax credits, they dont quite are not quite as generous as obamacare but even though replacements if you want to call it that, is still has a lot of elements. If you are arguing any plan that attempts to offered tax credits to the uninsured is somehow obamacarelike, halfdozen to nine different plans, that are obamacarelike. I contend that republicans and conservatives for a long time have said the best way to reform the Health Care System is to let patients have the dollars, let people buy whether it is healthinsurance or generous healthInsurance Plans or catastrophic plans, as michael advocated in the past let people have those options and let people buy plants that make sense for that the question is not the end results which we all shared but how you get there and with any replace requirement, 60 votes in the senate, and we can do what we do if republicans control 60 votes in the senate. Here are some options, we can do it through repeal, we can do it by migrating to the new system but what is important is having the end resulted having a lot of ways to get there so we can put together the legislative majority to get it done. What you are hinting at, there is a colossal difference between keeping the architecture of obamacare, and keeping it and huge difference. You misrepresenting that. You have called a lot of these plans obamacarelike. I wanted to get your thoughts on this. Republicans, conservatives, republicans conservatives i dont say we because im not a republican and not a conservative but republicans and conservatives have gotten themselves 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. So they have fallen for ideas like an individual mandate because they didnt think this through enough to realize an individual mandate, the coercive power of government provides Health Insurance l. A. Single payer system does two degrees of the same animal. And end ed up with 60 votes in congress, republicans were not following their principles were thinking closely enough about these things. Tax credit, and obamacare like, a lot of redistribution like obamacare does and individual mandate. And you dont or pay more money to the government. Thousands of dollars. And not obeying the may you purchase Health Insurance. And withheld Insurance Plan looks like, what the individual mandate does. And these are obamacarelike plants and i dont think, get 60 votes in the senate. And get 60 votes in the senate at this point and think these obamacare is a like proposals are the way to go. If they do that they reveal obamacare and replace with obamacare is a light they will have obamacare, bipartisan support at every get rid of it. On the flip side of the 60 votes in the senate, you never get 60 votes for reconciliation. For the repeal of obamacare, an alternative on the horizon. People look forward some alternatives the deal with coverage, and mike and i were testifying in the senate and made a similar point, claim that a tax credit is roughly akin to the individual mandate in obamacare that a tax credit officially mandates that you buy insurance. By that logic the Child Tax Credit mandate everyone have a child. Who would make that argument . Childless couples are annoyed by that. You can take anything to a theoretical extreme but theres a profound difference between the government mandating that you buy a product or service, the federal government for the first time in American History, and offering a tax break in whatever form to people who choose to buy. There is a tax credit for child care. A lot of stay at home families, stay at home parents are really offended that they are effectively being penalized by the tax code because they made the choice to stay at home and raise their children. Perfect example. A factual comment, mike said the tax credits are a mandate to buy insurance. That is not true because you could structure the tax credit so is deposited in Health Savings accounts which means you dont have to buy insurance with it. You could use it to just save through compound interest and have it roll over for your health care needs. Not necessarily through the tax credits healthinsurance tax credit talking about Health Insurance, even healthinsurance. Healthcare or both. For a lot of people it would be a government cash payment from the government into Health Savings account. The key thing to point out here is there is this distinction between a tax credit and Tax Deduction and if it is had tax credit in means that it could probably be extended to more people because people at the lower end of the income spectrum that dont have a high Tax Liability could still get the same amount of money whether it is 2,000 or whatever. It is a tight cash payment from the federal government. Anything beyond what the tax liabilities of that person becomes the equivalent of a product subsidy as opposed to a deduction which just when met somebodys income Tax Liability but that doesnt benefit all loss of uninsured people who dont have much liability. What we need to do it for them, because anyone controlling their Health Care Dollars and spending every one of those Health Care Dollars as if they own it, if we get 150 Million People spending health care more wisely that is the most important thing we could do for people of modest means because that will spark a revolution in Cost Containment and drive prices down remembering health care and the reach of more people but the point you make is important. This is criticism that i got of governor Bobby Jindals standard deduction for Health Insurance, better proposals and Health Insurance tax credits because it does not involve redistribution but anytime you have Government Conditioning a benefit, subsidy or a tax cut it has to define what x is so people dont know if theyre eligible for the Tax Deduction. Standard deduction for healthinsurance let the government define what your Health Insurance plan looks like because what insurance qualifies for that deduction. I think as i said before, not just because it is here but i said before the i think governor Bobby Jindals healthcare proposal is the best i have seen among the republican candidates that has a serious flaw. You want to click on that, i want to move on. Biggest difference on the right, who believe we have to have an alternative. Theres some disagreement there. I think it is very clear publicly, we have to have an alternative. The American People have been waiting to see what will go in obamacares place. The biggest disagreement has been between tax reduction of pro tour tax credit approach. Philosophically, to offer a tax credit, we are operating in a political vacuum no problem with a Tax Deduction based approach but were not operating in a political vacuum and we are in a wor