Bottom Line Up Front: It isn’t good. But it isn’t as bad as many people are saying. Reforming health care is harder than anyone is admitting.
So is the GOP Congress saying this is the final version of their health care goals? Or is it a transitory law to tide over until final law?
Because while I do, of course, want more market-based reforms, not sure we can get there in one single jump.
There is so much wrong with our current health care system. It really is just Pre-Paid Health Maintenance Plans. This separates price from cost, which makes things more expensive. Moreover, it punishes those who are cautious with their health, and reward those who are reckless and consume more health care. Imagine how much it would cost if vehicle fuel were sold under and “insurance” plan where you paid a monthly fee and could use as much as you wanted. The person who commutes 5 miles a day in a Mazda Miata would be subsidizing the person who drives a Hummer 90 miles every day, takes long trips every weekend, and is a leadfoot.
So the first order of business is to wean the nation away from the current Pre-Paid Health Maintenance plans referred to as “insurance.” But that’s only the beginning. We need:
- insurance to pretty much be only catastrophic.
- retail clinics where RNs triage for need to be seen by PA, who then triages for need for specialist. Basic check an illness isn’t serious for out-of-pocket money.
- hospitals and doctors to publish prices and full fees for all treatment.
- a system to allow people to be guinea pigs for new treatments *if they want*, i.e., the rich and the terminal, w/o lawsuit threat.
- a total reform pharma laws so there aren’t perverse incentives in development, especially patent rules.
- effort to get bulk of medical care shifted to out-of-pocket, to reduce paperwork overhead, increase competition, and increase choice.
- plan resolve exploitation of “free” medical care to illegal aliens. At the very least, that means new, robust collection laws. Could also mean ensuring all illegal aliens leave. Can’t reform healthcare w/o it.
- A cap to end-of-life costs. The tricky part is if you heal the problem, it won’t be the end of life. But when people pay for insurance (even catastrophic), they don’t want to be told a cost restriction prevented them (or their loved one) from getting treatment. We need to get people used to the idea that there is a reasonable amount that others will be willing/able to pay to save a life, but beyond that, the costs should be borne by the family and friends that love them most. Because as in most things in life, there are few easy choices, and with each choice comes drawbacks and other unpleasant consequences. Part of being an adult is deciding which unpleasant consequence is the easiest for you to accept.
It takes time to get massive, cumbersome health care system to shift to the free market-based solutions. This can’t be done in just a few weeks. Particularly since there are powerful lobbies that want to prevent market based-solutions from taking away their golden parachutes.
Even worse, the public itself is a huge part of the problem. We are never going to improve health care until we get people to grasp Medicaid doesn’t improve health outcomes. Of course, this also needs to be understood by people who have enough money to never be on Medicare. We need everyone to understand that just having medical coverage is not health. Health insurance is an illusionary security blanket that people want, and will give up rights and money to the government to get it. That illusion is part of what is making it so politically difficult to repeal Obamacare & reform healthcare system.
Imagine they repealed Obamacare completely yesterday. The first thing that would happen is the news organizations would be screaming about all the people who are no longer covered. They would be doing their best to stir up panic. Repealing Obamacare wholesale would push most of the population to consider (and perhaps embrace) Single Payer, just to have that illusion of security. It would be a political disaster.
The most likely outcome is Democrats would take back Congress in 2018. I do not have confidence that President Trump would veto Single Payer with such an obvious mandate; he doesn’t have any history of commitment to free market principles, and pretty clearly seems to want to be remembered as a President that served his people. Giving them Single Payer when they seem to want it would satisfy his ego.
So we can’t just throw 10s of millions of citizens into a free market system. That would be a political disaster that would most likely lead to Single Payer.
What if we go back to the previous system?
Was anyone happy with the previous system? It was still a Pre-Paid Health Maintenance system. We still had spiraling costs because price and cost were not obviously linked. Democrats would demagogue the crap out of it. It seems like it would end up in the same place as no plan at all: Democrats take Congress, and we get Single Payer.
So I’m okay with some incremental changes for now, or a transition plan. But yeah: I’m not happy at all if this is their final plan.
The Good Points:
Right now, I think there is no personal mandate. The mandate is to insurance companies to provide to anyone. They had to keep a penalty in so that people wouldn’t wait until sick before buying insurance (which destroys the benefit of risk pools). But the penalty is from the insurance company for letting your insurance lapse, not from the federal government for not buying insurance. That’s slightly better.
Still, I agree with Ben Shapiro’s conclusion: “you’ve actually created a gradual cementing of key elements of Obamacare.” They just made Obamacare into GOPCare. But how do we *get* to market-based health care system with *real* reform w/o losing Congress and getting Single Payer?
My best suggestion is to spend the next three years in preparation: write legislation that encourages Retail Clinics. Pass Tort Reform. Deport enough illegal aliens that the rest self-deport, lowering the stress to the ER system and the cost to the hospital system. Pass laws requiring hospitals to post prices, so competition can begin. Then right after the 2020, then drop the big law that gets rid of any health insurance except catastrophic, caps heroic efforts, establishes tax-free health savings accounts, and pushes all the previous preparatory market-based reforms to 11.
Then sit back and demagogue to the hilt all the successes and improved health & cost outcomes. This is one area the GOP always fails: they seem to not have a plan to sidestep the Democrats’ ally in the mainstream news media industry. Trump has shown them how to use social media to get directly to the people; the GOP Congress needs to spend the next three years before they drop the big Reform Law preparing their PR blitz.
One other thing: Perhaps grandfather in anyone over 50? It is easier to wean the young from government health care, since they are mostly healthy, by and large.
I had little confidence in Ryan since the Omnibus last year. I had little confidence in him. He’s like meh to accidentally good. And yet, he’s *still* better than Boehner, and Boehner was *still* better than Pelosi.