Among the Many Major Parts…

I turned eagerly to this explication at The Conversation on how the Congress could address the problems with the Affordable Care Act only to be confronted by this:

The first question is what exactly do they want to repeal or fix. The ACA seems to have evolved into a great political Rorschach test somewhat devoid of real content but relying on projection of underlying beliefs.

For Republicans, it is evidence of governmental overreach and excess expenditures, while Dems seem to think of it as the essence of collective action and shared responsibility for those less fortunate. As such, neither informs the specific directions we might take from here.

In reality, the ACA consists of four major parts:

1. Expansion of Medicaid for low-income working poor, with mostly federal financing.
2. Research on alternative ways to treat conditions to inform physician practice.
3. Tests of innovative ways to organize and deliver health care for better value that can be quickly implemented across the system.
4. The exchanges, for purchasing subsidized individual policies from private insurance companies.

That prompted me to think about the Monty Python sketch shown above. Among the many major part of the ACA…

By what stretch are the last two major components of the legislation? They certainly weren’t what the CBO thought were the legislation’s major components. It thought they were:

1. The Medicaid expansion (initially the largest part)
2. The exchanges (eventually the largest part)
3. The individual mandate
4. The employer mandate
5. The tax on “Cadillac plans”
6. The excise tax on medical devices

to which I would add the regulations imposed upon qualifying insurance plans and EMR. Methodologically, you shouldn’t intermingle unquantifiable objectives with quantifiable ones which is what the author of the post seems to be doing.