The cry of the day is that Obamacare cannot be fully repealed because it’s changed too much. It’s true that one-sixth of the economy became entangled in its massive web.
Speaker Paul Ryan told a CNN town hall this evening that Obamacare will be repealed and replaced at the same time. Good. But let’s be careful about what we replace it with.
“We want to do this at the same time, and in some cases in the same bill,” Ryan said during a town hall in Washington sponsored by CNN and moderated by Jake Tapper. “So we want to advance repealing this law with its replacement at the same time.”
Ryan said Republicans are moving “as quickly as they can” to repeal and replace the Affordable Care Act, but said he doesn’t yet have a date, and it will take “a little bit of time” to do so.
“We’re working on this as fast as possible,” he said, adding that the GOP will act “definitely within these first 100 days” of Trump’s presidency.
My best analogy for this is from the 1986 sci-fi horror classic, “The Fly.” When Seth Brundle (Jeff Goldblum) programs his telepod device to decode living material at the DNA level, then unknowingly teleports himself along with a tiny passenger, his DNA becomes irretrievably enmeshed with a common housefly. After he begins to exhibit the strength and physical features of a fly, he checks his computer logs. The computer calmly informs him that he is no longer Seth Brundle, but is now Brundlefly.
The ACA fused the model for American healthcare, which has been independent, for-profit insurance companies underwriting health risks for known pools of healthy and sick people, with a single-payer mandate to create a huge “exchange” for health care insurance, with standardized plans. The result was supposed to be lower costs as the healthy people pay for the sick, and the wealthy pay for the poor.
But enough holes were built into the ACA that a giant Brundlefly could barrel through it, and the plan failed to gain enough of a healthy risk pool to continue. Insurance carriers pulled out of markets, exchanges failed, and other carriers went bankrupt. American health care is sicker than it’s ever been.
But like Brundlefly, there’s no way to unfuse the DNA. What’s done is done to the market. Further, the Senate has knocked out the budget pillars funding the exchanges and the individual mandate, so the current ACA system as legislated is dead, whether it is fully repealed or not.
But as Daniel Horowitz so cogently explained in Conservative Review, the problem with health care is not the government discussing “repeal and replace,” it’s getting back to basic principles.
When Republicans refer to “repeal and replace” they really mean bait-and-switch because they are accepting the premise that we need to keep the pre-existing condition coverage mandates that are responsible for unsustainable costs along with refundable tax credits (which are subsidies in all but name only) in order to sustain the higher prices. Accordingly, when they say they are concerned we must not repeal Obamacare unless we have a replacement plan in place, they mean we must not repeal the coverage regulations until we have similar regulations in place. Likewise, they mean we must not repeal the subsidies until we have a pale-pastel version of the subsidies in place.
The problem is that these Republicans, and the pundits offering their own hot takes, are conflating “plans” with “government programs.” Surely there needs to be a plan for repealing Obamacare. It would be wholly irresponsible for our federal government to defund the hydra choking our economy and our health care system to death without offering a plan for what will follow.
But it’s a mistake to make that plan be “ACA 2” or “Trumpcare” or some other snazzy-sounding panacea that really solves nothing. Democrats will cry that millions (up to 20 million) of Americans will “lose coverage.” But they don’t mention the fact that 100 million more Americans are spending way too much for way too little, and there’s no top-end to the cost model inflating to infinity.
There was much wrong with American health care before Obamacare was shoved down our collective throats. But those problems were more correctable before the ACA. Now we’re in the same position BrundleFly found himself in when he ended up being fused with a telepod at the movie’s penultimate scene. Mortally wounded and suffering, he begs for death.
Obamacare must not be replaced, it must be euthanized completely.
Congress must look at the AHCRA as a starting place for health care.
- Eliminate state silos for coverage pools and allow interstate competition. Standardize coverages, by all means, but allow states to coordinate the risk pools and regulate the plans.
- Unbundle all those “mandatory” coverages from basic health insurance, and allow healthy people to obtain high deductible plans with useful health savings accounts that companies can contribute to.
- Enact litigation reform and drug cost and distribution controls to reverse the shameful opioid addiction epidemic. Possibly set up a federally chartered corporation to help with drug price negotiation and distribution, and license generic versions to stop gouging.
- Fund life-saving research into less profitable diseases.
- Let doctors’ groups negotiate directly with health networks, and take away the gordian knot that hospitals, Accountable Care Organizations (ACO’s), mandated reporting and EMR have created.
- Turn the tables and force health care networks to justify their negotiated prices for medical services. Insurance carriers have to get their rates and risk pools approved by state regulators, but networks can drop doctors or treat them like slaves. No wonder the medical profession is becoming less popular.
- Allow medical tourism as a standard coverage for patients who wish to travel to other countries for treatments that aren’t available in America.
People want healthcare coverage. They want to pay a reasonable cost, not more than their mortgage payment, that will give them relatively cheap office visits, one examination a year, recommended cancer screenings, keep their prescription costs low, and not let them go bankrupt in the event of a major health crisis or emergency. And if they want to go it alone without coverage, let them.
This isn’t too much to ask. We don’t need to pay Medicare for millions of people whose primary care physician is the emergency room and their main way of getting there is by ambulance (to treat the flu). If there was any individual mandate I’d support, it would be one requiring anyone who wants Medicare to choose a primary care physician and see them first for routine issues, and show up once a year for a physical. But liberals don’t want to burden the poor–just everyone else.
Health insurers would love to offer plans that Americans want to buy. They’ve had their noses so far up the government’s rectum for the past decade that they don’t even know how to ask consumers what they want anymore. It’s time the federal government got out of the business of figuring out what a free and liberated population of Americans needs, and instead just asks them.
Then let the insurance carriers work out the details, with some guidelines and input from state regulators, who have been doing their jobs for many decades. Get everyone in a room, don’t let them leave until they’ve got a plan, then figure out how to get there without keeping Brundefly alive.
It’s going to be hard, but it needs to happen. Just dismantling parts of the ACA is betraying Americans who elected Republicans to office specifically for the purpose of killing it completely.
A message to Congress: we need a plan for American health care, but we don’t need another government program. Don’t give us one.