We Still Need Health Care Reform
The Obamacare fiasco is an almost perfect illustration of the difference in approach to government by the left and the right. Liberal pundits routinely depict conservatives as uncaring, but the fact is that both sides fundamentally agree on the need to provide all Americans with affordable health insurance. Indeed, government insurance exchanges and universal mandates originate from Republicans, but the ways to achieve goals are vastly different from right to left.
Conservatives would prefer to provide a catastrophic health care safety net for all while also lowering total medical expenses for all Americans. This would be accomplished by providing a regulatory framework and allowing the states and market forces to achieve their objectives. Examples would be to allow insurance to be sold across state lines with limited mandates as to coverage requirements and making health care insurance portable and permanent.
Progressives fundamentally believe the federal government should mandate coverage requirements for all that include routine health care, and that the program should employ a wealth transfer mechanism whereby care for the poor and chronically ill are subsidized by wealthy and healthy Americans. This vision is similar to the Social Security system, which originated as a safety net program and not as insurance. Like Obamacare, Social Security was supposed to be self funding via mandatory payroll taxes, and benefits would be available to all regardless of payments into the system. (Can we imagine a new introduction of Social Security in an era of distrust of government?)
The Affordable Care Act Needs to Be Replaced
Obamacare is on life support, and it is almost certain to fail. Once the fiasco of the healthcare.gov website is fixed, there will be a continuing cascade of problems to hit those newly enrolled in the system. Until now, anyone who appeared at an emergency room for catastrophic care was treated regardless of their ability to pay. Obamacare expands to the 45 million Americans previously without health insurance the right to seek care for routine health issues from the current provider network, while at the same time reimbursing those providers at a lesser rate than private insurance plans and individuals. Adding 15% more patients to provider workloads logically requires an expansion of service providers, but this has not been done. Waiting times for appointments will be rapidly extended for public patients, even as private patients secure shorter access. Many providers will begin to restrict or eventually refuse to accept public patients, much as has previously occurred with Medicaid patients.
As newly insured patients demand more routine and preventive care from the system, costs will escalate and require higher premiums from those not subsidized by government. Total costs for all health care will expand even as the program fails to be self funding. Americans now understand that the essence of the Affordable Care Act is that millions of people are being conscripted to buy overpriced policies they would never choose for themselves in order to spend on the poor and those who are medically uninsurable due to pre-existing conditions. In essence, this will be a wealth transfer mechanism from the middle class to the poor. It is not insurance in the classic sense. Obamacare does not only cover unforeseen events. It is meant to cover most, or all health care expenses. Since one can enter the system with small penalties at any time, why not avoid entry into the system until one has a need for services? In “real” insurance systems, one buys coverage for say fire insurance to cover the small probability of a catastrophic event. Under Obamacare, one buys fire insurance after the fire has devastated your home.
The Affordable Care Act provides people with access to health insurance rather than access to medical care. The health insurance and pharmaceutical companies are entirely complicit in this disaster. Seeing only riches in millions of new customers required by law to buy inflated coverage or pay a (voluntary/optional) tax, they ghost wrote long sections of the ACA, which all congressional Democrats voted for “so they could find out what’s in it”. Diogenes, for one, would like to see the insurance mandate commuted to catastrophic (requiring surgery or a hospital stay) medical care. Routine care could be “uninsured” for all. Making these routine expenses discretionary might well allow medical care providers to compete on service/quality and price, as do almost all services providers.
Now Could Be A Great Time for Reform Because of What We Have Learned
In our hyper partisan political climate, it is difficult to imagine that America’s health care problems can be remedied by legislative action. But the failure of the ACA provides just such an opportunity. After warning for years about the impending disaster of the ACA, conservatives finally have earned some credibility concerning how to restructure a health care safety net. Liberals who would like to salvage that goal without ending their political careers could finally reach across the aisle to find real solutions.
Obamacare will in time be seen as the high water mark of progressive government. The administration’s many foreign policy failures have meant little to most Americans who do not pay attention to world affairs. Obamacare is different in that it hits many directly in their wallets. We are now approaching another crossroads in the health care debate. Liberals will say that the solution is a single payor system run by government. Conservatives point out that embarking on a single-payer system would not expand access—though that slogan would be used—but would deny and limit care in order to control runaway spending. After the disaster that was the roll out of healthcare.gov, who in their right mind would want to give our central planners even more power?
45 million previously uninsured Americans need to have access to health care that does not bankrupt them or the rest of us. As a society, we can afford to do this, and the moral imperative is that we must do so. The federal government, having assumed the job of subsidizing these people, should do so honestly and openly. Instead of the 2000+ page Rube Goldberg system under the Affordable Care Act, we need a simpler framework that allows a multitude of alternative solutions at the state and local level. Expanding the role of a ridiculously inept government would be madness.