Concerning the new official Republican House health care proposal, Michael Cannon writes,
The leadership bill therefore creates the potential, if not the certainty, of a series of crises that Congress will need address, and that will crowd out other GOP priorities, in late 2017 before the 2018 plan year begins, and again leading up to the 2018 elections. If Congress gets health reform wrong on its first try, health reform could consume most of President Trump’s first term. Pressure from Democrats, the media, and constituents could prevent Republicans from moving on to tax reform, infrastructure spending, or even Supreme Court nominees.
Avik Roy is more favorably disposed to the proposal, but with significant misgivings. I tend to agree with his “cons” and disagree with his “pros.”
The WaPo story on the proposal says
four key Republican senators, all from states that opted to expand Medicaid under the ACA, said they would oppose any new plan that would leave millions of Americans uninsured.
It would take a lot of nerve to say: Our plan is to hold households responsible for obtaining health insurance. Some households will “lose” coverage that was heavily subsidized by the government. But if you cannot stand up and say that, then you cannot change the direction of health care policy away from socialism.
As I wrote recently, the Overton Window has moved, so that responsibility for health insurance is strictly with the Federal government, not with the household. Along similar lines, Philip Klein writes,
Barring radical changes, Republicans will not be passing a bill that ushers in a new era of market-based healthcare. In reality, the GOP will either be passing legislation that rests on the same philosophical premise as Obamacare, or will pass nothing at all, and thus keep Obamacare itself in place.
After digesting these and other analyses, I am inclined to think that Obamacare will not be repealed and replaced during the Trump Administration. Instead, it will be repealed and replaced by the Democrats the next time they are in power. And the replacement will not look very market-friendly.
Legalizing inexpensive plans could be a way through the conundrum. Not to mention, forcing everyone to have the premium product is insane.
In other words, we should do it tomorrow, and if it doesn’t halt premium skyrocketing, so what, it was the right thing to do. I told everyone before ACA did the wrong thing that it was barely even arithmetic that told us premiums would have to go up. It wasn’t even math. It was counting.
Probably, the insurance industry was not interested in legalizing inexpensive plans, so the Republican congressional leadership never thought of this.
The requirements for insurance plans under Obamacare are set by regulation, so the Trump administration could change these without congressional action, but apparently nobody in the Trump administration has the wit to think of this.
Then they should read this blog and do it before lunch.
We can’t discount the possibility that this is all some kind of theatrical performance and negotiating tactic rather than a genuine proposal.
That being said, Hansonian medicine implies there is plenty of room for cost reduction, so if we’re doomed to have Socialism, we should at least be able to lower prices.
Alas, republicans just spent 8 years disparaging any attempts to cut the harmful fat.
How can the GOP use a proposal that would destroy them if enacted as a negotiating position?
Our plan is to hold households responsible for obtaining health insurance. Some households will “lose” coverage that was heavily subsidized by the government.
No some households will lose coverage period because of pre-existing conditions. And without employer based insurance, our family would not be covered or covered if we did not include one of our children.
I am inclined to think that Obamacare will not be repealed and replaced during the Trump Administration
It is important to remember of Trump’s “Revolt Of The Elites” won a lot former Democrats that were not complaining about Environmental Regulators and Teacher Unions. They were complaining about the free market outsourcing jobs, illegal immigration which hurt the WWC communities.
Pre-existing conditions are not insured for. They should be paid for from HSAs.
Health in general can’t be insured for. There have been a lot of attempts to offer long term health insurance, and they have all failed. It’s just too hard a problem to solve, with lots of failed products along the way.
So nobody is willing to sell insurance for the long term, which means that if you get sick with a chronic condition, its inevitable that you will need to renew while having a pre-existing condition.
It’s quite frankly much easier to admit that society is just going to subsidize those born with expensive medical conditions. Once you admit to it, you start asking the question of how to manage it well, rather then constantly fighting over who has to cover it.
Ate you saying that the law mandating covering pre-existing conditions has also failed?
Because, if what you are describing is actually a form of rescission, that is already illegal and correctly so as a former of breech of contract.
Here is something you can’t ask in polite company: what if we spent the subsidy money treating these conditions on research to find inexpensive cures.
What I’m saying is go out into the market and try to buy a thirty year major med health insurance policy. This is true of guaranteed renewal as well. They don’t exist, and not for lack of trying on the part of insurance companies.
So you can’t own a health *insurance* policy the way you own term life.
The only way to make it mimic “insurance” is if you have pools and make both sides unable to select against the pool. So on the insurer side you have to make screening for pre-existing conditions illegal and on the insured side you have to force them to pay premiums. Then it becomes kind of like insurance in that you pay in for a long time and if you happen to get cancer your covered for as long as treatment is necessary without getting thrown off the plan or refused a renewal.
A good reform requires an honesty that you won’t find in either party to even 5% of what you actually need.
I wrote several months ago the best thing for the Republicans to do is simply let the ACA exchanges die all on their own. At that point, whoever is in power gets to fix that. You can make a good case for this being the actual strategy of the House leadership as demonstrated by the badness of the proposal.
Sure, let 6-12 months go by and watch the Republican and Democrat squishes sweat as Trump tweets “I told them we had to fix this sinking ship, but they decided that the public didn’t matter – so bad and so needless.”
Also – “Obamacare is like a corpse that is not getting better with age – what a stinker!”
Pretty good.
” I am inclined to think that Obamacare will not be repealed and replaced during the Trump Administration.”
I might make that bet, too, if it weren’t for slow-motion death spiral occurring on the exchanges. What does Obamacare look like if it remains the law of the land, but there are no providers in many places and astronomical prices (that reflect a very sick pool) in others?
They’ve never heard of Goodman or Cato?
God forbid they call Heritage.
The overarching goal of the Democrats was to get everyone in the same boat. They could undo this piece by piece. After two weeks nobody would remember “repeal”.
Cato should do a week-long conference. Probably already have.
I do consider the “default” Government option of the “single-payer” a very high probability eventuality – and that for both Democrats and so-called Republicans. It is going to appeal to both (all politicians) from at least two different perspectives: 1. It is the political “path of least resistance” expedient (short-term), 2. It is the path that leaves Government in absolute control of both health care decisions and cash flows (long-term).
Note that it is that second reason of leaving “Government in control” that is probably most abhorrent to me and (hopefully) most Americans with regards to a “single-payer” system. But that which I consider abhorrent, will appeal most to “politicians”, irrespective of what letter they have after their name on the ballot.
Free market health advocates can’t agree on a basic policy direction. Specific people have specific ideas, and good ones, but as a crowd, the free market advocates aren’t even close to any kind of consensus. That’s the problem.
Trump was elected to smash through Overton windows. That is not the major obstacle.
Also, even free market types want some safety net, which you can call insurance. EMTALA is a federal government safety net insurance program that free market types don’t complain about. And more than EMTALA, most free market types do think there should be some bare bones level of government guaranteed medical care.
This shows there was never any replacement; it was always about repeal.
Responsibility without the capability to fulfill it is fictitious. Responsibility implies the resources to fulfill it. Responsibilities imply rights. The right to die in the street is not popular, even among those who needn’t fear it. Healthcare is powerful at extracting resources; making those who prosper from it pay is only fitting.