Late in the Day

The editors of the New York Times have a strategy for alleviating the problems with the Affordable Care Act—more subsidies:

Congress and the next president could further strengthen the health care law by offering subsidies to middle-income families who currently receive little or no help. Lawmakers should also consider applying to the health care exchanges the kind of reinsurance program Congress has used to encourage insurers to participate in Medicare’s Part D prescription drug benefit program. The Affordable Care Act’s flaws are fixable, but only if politicians from both parties work together in good faith.

Let’s be clear. Both of the measures they propose are subsidies, one provided to insureds and the other to insurers.

It’s a bit late in the day for the editors to be appealing to good faith. It was power politics that has carried the ACA so far and it will be power politics that continues to sustain it.

Just for the record, I hold no antipathy to the Affordable Care Act and never have. I have always thought it was a sideshow that distracts us from the reform that we really need: lowering the cost of healthcare. It is arithmetically obvious that as long as healthcare spending continues to rise at a multiple of the rate of prices and incomes in the non-healthcare economy that federal healthcare spending will require more and more money as well as a greater proportion of total spending.

Oddly enough, a measure has recently been introduced that actually might do that: MACRA. It’s a series of changes and regulations governing how Medicare reimbursement is to be conducted.

The reason I say “oddly” is that there’s very nearly radio silence about it in the general press. It could potentially end up being more significant than the ACA but it’s not without risk. One of these days I’ll get around to posting about it.