Obamacare is dead! Long live Obamacare.
The Republican Party will control all branches of government
in January, and has a stated purpose to repeal and replace Obamacare (properly
the Affordable Care Act).
Repealing Obamacare may not be as easy as it sounds, and replacing it has many risks
and uncertainties.
Both parties agree the system needs reform. That is about
all they agree on.
Repeal:
Obamacare care is much more than a piece of legislation, it
is now six years of regulation and innovation, and is intertwined through the
health care system. There is no unpeeling of an apple.
There has been much to like about the intentions of
Obamacare, even if the design and
implementation were often
wretched. The latest regulations on Medicare physician payment run to 2171
pages of complex and convoluted
regulatory excess.
Obamacare gets a good grade on intentions, but not so good
on design or operations. Still, a full operational repeal is not possible, too
many changes are ingrained into the system for a full.
Replace:
Timing is everything. I just finished reading House Speaker
Paul Ryan's A Better Way plan
including the health care section. Whether or not Ryan is popular with his own
membership, his health plan lays out the key ingredients of any GOP or
conservative health reform plan. I am not impressed.
Leading the list are Health Savings Accounts (HSAs) and the
interstate sale of health insurance policies, neither of which are likely to
provide the salvation promised.
Health care markets do not work like the markets for buying a shirt, a car or a head of lettuce. The HSA idea may
be overrated as a tool of salvation, but good for the affluent.
The interstate sale of insurance policies saves money only
if the insurers under price their products, and that can only happen for a few
years before something bad happens. This is much like several of the ACA
exchanges. I fear interstate sales will empower 1-800-Lousy-Policy companies, a
consumer nightmare in the making.
The replace program promises cost savings through consumer
choice, a profound misreading of how consumer find and use health care.
Like most GOP initiatives, the plan works well for the
affluent and not so well for anyone
else. And when the GOP talks about “protecting Medicare,” I know we are in trouble. The pro-life GOP
will find a way to punish Medicaid recipients, count on it (and punish
hospitals in the process).
Curiously, the GOP plan for patient protection includes many features – wait for it – of
Obamacare, just without the details. Lots of buzzwords though.
Perhaps I am a bit too cynical, but I think not. The Trump
administration will be a wild ride on many counts, and not the least of it will
be health care.
