Healthcare and the Pig

There's an old adage—putting lipstick on a pig doesn't change the fact that it's still a pig. For many reasons including the fact that the entire program is collapsing before our eyes, Obamacare (The Affordable Care Act) is a pig. Those of us who opposed it from the beginning stated that it would be exorbitantly expensive, would raise, not lower, the costs of medical insurance, would limit health care options (remember: "you can keep your doctor"), would harm small businesses and stifle the growth of those businesses, would be managed incompetently, would be rejected by large segments of the public, and would irreparably harm a private health care system that for all its faults, actually worked pretty well. The Democrats, driven by their ideological zeal to create yet another entitlement on the road toward "universal health care" didn't listen. A pig was born.

Now as Obamacare literally collapses (e.g., very expensive coverage with $8,000 deductibles, some countries with one or no insurers, major insurers dropping out of the program, 20 million people opting for a tax penalty rather than participation, the young and healthy bailing while the old and sick drain the system of resources), the GOP jumps in with lipstick.

It's reasonable to ask why, after 7 years to think about it, the GOP hasn't come up with a workable and innovative plan to replace the pig. Instead, it appears that they've opted for lipstick. There are certainly procedural, policy and political issues that may have forced them to roll out a plan (phase 1) that nobody seems to like, but come on man!

Ed Morrissey comments:

One challenge facing Republican leadership is the reconciliation process in the Senate. Harry Reid famously used that budgetary exception to pass Obamacare on a majority vote, eliminating the use of the filibuster. However, only legislation with a specific impact on the federal budget can cite reconciliation to avoid the filibuster. That limits what the repeal bill can do and still be passed on a majority vote. The AHCA necessarily only addresses those portions which qualify under Senate rules.

The next complicating factor is Donald Trump’s promise to ensure that Americans don’t get abandoned in the process. That’s almost certainly why the AHCA does not eliminate the Medicaid expansion immediately, as House conservatives had hoped, and why this plan continues the practice of subsidies for health-insurance purchases. The need to extend both of those for the next few years stems from the difficulty of getting a full replacement program through the Senate; Republicans clearly hope to have a filibuster-proof majority after the 2018 midterms, but need to leave some measures in place before then.

That doesn’t necessarily make the AHCA the best bill that can pass under these circumstances, but it does explain why Republican leadership may have refrained from producing a final, full-scale repeal-and-replace bill in favor of a transition plan. And the White House has responded to criticism of the plan by offering to negotiate amendments through the legislative process. Tom Price, former chair of the RSC and now Secretary of Health and Human Services, made that explicit on Tuesday.

This phased approach is dictated by political realities. So phase One sucks. What about the follow-on phases 2 and 3.

Both sides of the ideological spectrum are—as is often the case—wrong on medical care. The Right wants a purely market-driven approach that sounds good but isn't workable after an entitlement (free stuff) has been created for millions. Removing the entitlement will be demagogued to death by the Dems (the current operative word is "mean!"). The Left dreams of universal coverage, and will accept nothing short of it. They live in a fantasy world ithat rejects the notion that the enormous medical costs for a country of 320 million people wouldn't result in scarcity of coverage, bankruptcy for the treasury, and inferior care for the most vulnerable among us.

What to do?

There are no easy solutions, but a good start would be comprised of the following elements:

1. Catastrophic health care coverage for all Americans —premiums means-tested based on income, and where necessary, paid for by the taxpayers. This would preclude the Democrat claim that people are uninsured and that many are bankrupted by major hospital stays.
2. Two doctor visits per year for all Americans—premiums means-tested based on income, and where necessary, paid for by the taxpayers. . This would allow physical exams to be conducted so that small problems are found before they become big ones.
3. The right to maintain insurance once sick, if and only if the policy holder had insurance and lost it. If, however, the citizen voluntarily dropped coverage, then got sick, he/she has no right to pre-existing conditions coverage. Decisions have consequences, and bad decisions often have bad consequences. 
4. The instantiation of tax deductible Health Saving Accounts to replace any attempt at universal dollar one coverage. No tax credits, no subsidies, but an individual's money used for rainy day medical protection.
5. An open private sector medical insurance market for remaining coverages with a wide array of policies and coverages tuned to the buyer's needs. Policies could be purchased nationally.
6. Tort reform to eliminate the enormous costs associated with malpractice suits and unnecessary tests as CYA measures among doctors.
7. Reform of FDA regulations that allow drug approval in 25 percent of the current time and 25 percent of the current cost with commensurate (and significant) reduction in prescription drug costs.
8. Allow states to control medicaid costs and even create specialized clinics that provide care to in indigent at reduced cost.

The elements listed represent the core of a healthcare plan that might not be a runway model, but it certainly isn't a pig either.