The To-Do List

by Dave Schuler on March 23, 2014

John Goodman has a to-do list for reforming the PPACA:

Getting rid of the mandates, letting people choose their own insurance benefits, and giving everyone the same universal tax credit for health insurance would be a good start. More easily accessible health savings accounts for people in high-deductible plans is another good idea.

Every provision in ObamaCare that encourages employers either not to hire people or to reduce their hours should go. Everything in the law that prevents employers from providing individually owned health insurance that travels from job to job should go. And everything that makes HealthCare.gov more complicated than eHealth (a 10-year-old
private online exchange) should go.

I presume that most of the things that make HealthCare.gov more complicated than eHealth are due to its need to interact with an alphabet soup of government agencies, each with its own mutually-incompatible, frustrating, and obsolete access method. Those are in desperate need of reform but, sadly, experience suggests that they’ll only be reformed when it’s absolutely, positively, ten years later than they should have been replaced and then they’ll be replaced with something just as maddeningly obscure as what they’re replacing. What probably should have been done was to have established a set of standards in the context of the PPACA and mandated that the various agencies conform to them. Water under the bridge.

Meanwhile, I wish someone could provide a good explanation on the merits of why we continue to subsidize big business at the expense of small ones. It’s one of life’s mysteries.

Sadly, Republicans are in permanent attack mode while Democrats are in permanent defense mode. That makes it darned hard to hold an adult conversation on how the PPACA should be reformed.

{ 19 comments… read them below or add one }

Jimbino March 23, 2014 at 4:52 pm

It apparently needs to be asserted time and again that health care is not insurance. What the Amish, the Brethren, I and others need and want is health care. What we don’t want is insurance.

Please stop confusing the two.

steve March 23, 2014 at 5:16 pm

There are so many lies and untruths in his piece it is hard to take it too seriously. We are not 4 years into the ACA. We are really about 6 months into it. When it was designed, it was not set up to achieve universal coverage, but to increase coverage. Etc, etc.

Anyway, what he gets correct is that it would be easy to modify. You could get rid of many of the mandates, though I think (this is hazy) you would still have to deal with state level mandates. Let people choose their own benefits? Pretty meaningless and we know that people have a very hard time choosing among different benefits and determining value. Much better to have a system where people can make apples to apples comparisons. Portability is an excellent idea. I suspect that his idea about giving everyone the same universal tax credit will mean that low income people still won’t be able to afford care, but maybe he means well.

Steve

jan March 23, 2014 at 10:31 pm

Steve, you continue to defend the indefensible. I recall you used to like John Goodman’s analysis. However, I guess he has gone too far by getting the consumer involved in their own health care options, and unwinding the arm-twisting of the government. Shame on him!

michael reynolds March 23, 2014 at 10:38 pm

It’s hard not to be on the defensive when you’re constantly attacked by people who think extending health insurance to more people is the moral equivalent of Dachau.

I don’t know any Democrat who has a problem with making reasonable adjustments. But as Steve points out, the original piece is hogwash.

Zachriel March 24, 2014 at 7:53 am

michael reynolds: I don’t know any Democrat who has a problem with making reasonable adjustments.

The rational method when enacting large programs would be regular course corrections, but that’s virtually impossible under the U.S. system which invests the minority with the power and the justification for obstruction.

The U.S. does have the Administrative Procedure Act, but the Republicans have decided that actions under this duly enacted law is rhetorical tyranny.

Still, it’s better than civil war.

Dave Schuler March 24, 2014 at 8:13 am

How many amendments to the PPACA have made it to the floor of the Senate since the PPACA was enacted into law?

jan March 24, 2014 at 2:33 pm

I presume that most of the things that make HealthCare.gov more complicated than eHealth are due to its need to interact with an alphabet soup of government agencies, each with its own mutually-incompatible, frustrating, and obsolete access method.

This comment about the government HC site is similar to this parent’s complaint about the Common Core educational design now being thrust upon the academic community — it’s all about complexity, which somehow makes everything so much better!

steve March 25, 2014 at 8:21 am

“How many amendments to the PPACA have made it to the floor of the Senate since the PPACA was enacted into law?”

14. Many were small, some were like the amendments to make Tricare work, and some were a bit bigger like the income reporting provision for small businesses. However, contra Goodman, the ACA is really just starting. I wouldnt expect a ton of amendments yet. We arent even through the first sign up period yet.

http://www.washingtontimes.com/news/2013/sep/11/study-obamacare-has-been-amended-delayed-19-times/

jan- Just because I like some of Goodman’s ideas doesnt mean I wont call a lie a lie.

Steve

Dave Schuler March 25, 2014 at 8:37 am

What you’re saying, steve, is that you can’t name any Democrats who are in favor of amending the PPACA but you’re just sure there must be some. I’ll name one who’s opposed to amendments: Harry Reid. The Senate Majority Leader has a lot of control over what comes to the floor. If nothing is coming to the floor, that’s the prima facie case that either a) none are being proposed or b) the leadership isn’t allowing them to come to the floor. Either way substantiates my claim.

Zachriel March 25, 2014 at 9:18 am

Dave Schuler: I’ll name one who’s opposed to amendments: Harry Reid.

It’s because, under the parliamentary rules of the Senate, a legislative amendment can be used as Trojan Horse. The Republicans have made clear their intention to undercut the law, not work to make it work better.

Dave Schuler March 25, 2014 at 9:35 am

Which was my point: the Democrats are in defense mode. You and Steve are excusing their being in defense mode rather than denying it.

Zachriel March 25, 2014 at 9:46 am

Dave Schuler: Which was my point: the Democrats are in defense mode.

Of course they are. It’s the nature of the U.S. two-party system, to lurch from side to side.

Zachriel March 25, 2014 at 9:48 am

Dave Schuler: Sadly, Republicans are in permanent attack mode while Democrats are in permanent defense mode. That makes it darned hard to hold an adult conversation on how the PPACA should be reformed.

In case you still missed our point, we agree with this assessment.

Dave Schuler March 25, 2014 at 9:52 am

That’s not true. Oppositional politics is a relatively new development in American politics. We have had two major political parties since we’ve had political parties but they are now much more specifically oppositional than they’ve ever been.

Now the parties are mostly sorted into two opposing camps with very little middle ground. The most conservative Democrat is now less conservative than the most liberal Republican. The largest growing political faction is now non-partisan, independent, or just plain disaffected. It hasn’t always been that way and if you think it has you just don’t understand American politics.

Dave Schuler March 25, 2014 at 9:55 am

In case you still missed our point, we agree with this assessment.

Thank you.

It used to be that moderates/centrists in both parties could form a nexus around which compromise could be effected. That’s evaporating and IMO it’s to the detriment of the republic.

Rather than what the most progressive Democrats seem to think I think that rather than resulting in a permanent progressive majority it’s likely to result in whipsawing (which you suggested above) or divorce.

Zachriel March 25, 2014 at 9:56 am

Dave Schuler: Oppositional politics is a relatively new development in American politics.

http://upload.wikimedia.org/wikipedia/commons/3/31/Southern_Chivalry.jpg

Only one civil war in over two centuries. That’s pretty good actually.

Dave Schuler March 25, 2014 at 9:58 am

Sadly, I agree. If this goes on, I think we’re heading towards civil war.

steve March 25, 2014 at 10:48 am

Query- Dont you think we ought to at least get through the first sign up period before we start pushing lots of changes? And, just for the record, Wyden has always been willing to amend it. He has pushed harder for portability than anyone else. The left of center health care policy writers are more than willing to make changes.

Steve

Dave Schuler March 25, 2014 at 10:56 am

Dont you think we ought to at least get through the first sign up period before we start pushing lots of changes?

You mean in six days?

I think the time for change is when it’s obvious the change is necessary. Let’s wait and see if that artery stops bleeding on its own rather than trying to staunch the flow! There will always be a pretext for postponing changes.

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