What lessons should we have learned from the entire experience of the Patient Protection and Affordable Care Act? I think that one of them is that, if you want a healthcare reform program to gain popular support, don’t promote subdividing care. Most Americans are not directly affected by the PPACA; they think they pay for it without benefiting from it although the reality is somewhat different.
Another is that bipartisan support for new social programs is obligatory if you want the program to persist beyond the sitting president’s term of office.
I’ve consistently argued that the PPACA’s partisan vote, as well as the arm twisting and faulty sales pitch accompanying it, created a foundation of unstable sand. The same vulnerability goes for all the heavy-handed EOs exercised to circumvent congressional input.
Every word and deed by Republicans regarding Obamacare has been a lie. Now they are going to hurt their own people, and this country, for no reason other than racist spite. The black president’s accomplishments must be erased by the white president just as Americans have traditionally erased the accomplishments of people of color.
Check back in a few years. Much of the opposition has just been the Republican opposition to anything Obama does.
The Republicans want to keep the popular parts of Obamacare, but get rid of the unpopular parts. The most unpopular part of Obamacare is the name Obamacare.
I have no idea what will come of this, but it’s very possible we will get some tweaks and cosmetic changes (replace the individual mandate that fines people with a tax break for those who have insurance?).
I think, at least hope, many of you will be surprised by how positive some of the healthcare reforms will be. I know Dems repeatedly accuse Republicans as having no plans/ideas as to how to upgrade and/or replace the current PPACA that is in place. However, the Republicans say they have lots of plans and ideas, and it’s more a matter of consolidation, consensus and having a new HHS secretary in place to execute an alternative.
I’m reminded of Dave’s schadenfreude thread, though, where he highlighted one party’s joy at seeing the defeat of their opposition’s agenda. I see this as holding true in the current (early) uncooperative attitude of the Dems, along with their premature predictions of doom and gloom.
As I see it Trump’s policies, and make American great again vision, will either fall like a stone, or will unexpectedly become a flotation vehicle creating a bigger economy and better jobs. It remains to be seen…..
People like everything about Obamacare but the name, and the fact that it has to be paid for. What they want is all the goodies and none of the cost, and Republicans are now promising some rosy future devoid of details (though still apparently enough for the truly credulous) in which it will be all goodies and no cost. We’ll just borrow the few measly trillion. Far better to deprive millions of coverage and run up trillions in deficit spending than to accept that a black man left a legacy. That is unacceptable.
So, yay, tax cuts! Yay, they’ll pay for themselves! Just like the last zero times! But don’t worry, it’ll be trillions of dollars of Republican debt, so it’ll be okay. . . until the next Democrat is elected at which point deficits will instantly become a huge problem. Doubly so if the Dem is a person of color.
Who can guess what deeply-held, core beliefs Republicans will jettison next week? Stay tuned. Actually, watch your twitter feed. I hear Trump is about to tweet a ‘no fat chicks’ policy.
jan: However, the Republicans say they have lots of plans and ideas
The only Republican plans I have heard of are RomneyCare, now known as ObamaCare, and selling plans in one state regulated by another state. And some general push towards HSAs and high deductible catastrophic health insurance (which is only a good solution for people who have no health problems yet).
And gutting legal remedies for malpractice. (I could get onboard a federally funded, no-fault insurance that helps consumers who are affected by medical error, if it would lower costs, but just capping damages is a terrible way to go)
Is there anything else? They have had 8 or 9 years to come up with a plan — health insurance reform was on the agenda during Obama’s 2008 campaign.
I’m reminded of Dave’s schadenfreude thread, though, where he highlighted one party’s joy at seeing the defeat of their opposition’s agenda. I see this as holding true in the current (early) uncooperative attitude of the Dems, along with their premature predictions of doom and gloom.
The Democrats are being more cooperative than the Republicans have been of late.
And, if Trump has some amazing plan for giving everyone access to health care, I will happily swallow my pride for the good of the country. I do not expect this to be an issue.
michael reynolds: People like everything about Obamacare but the name, and the fact that it has to be paid for.
Also birth control. Whether they really care or not, a lot of Republicans have made that the hill to die upon.
Any Republican alternative is going to have skimpier required benefits, particularly around reproductive health. I would expect lifetime caps to come back as well (they aren’t “death panels”, since there will be no panels. they are more like “life valuation” accountants)
Things we should learn?
1) Health care is hard. No matter what you do, problems will pop up. Any solution will be very easy to demagogue. Politically, the safest thing you can do if you want to stay in office is not participate, then criticize after.
2) It is really hard to use markets to control costs. No one really knows how to do it. One market mechanism, increased risk taken on by the pt in the form of higher deductibles makes insurance virtually unaffordable for many people.
3) Interest groups are very powerful. If you cater to them you get worse reform. If you don’t, you get no reform.
4) I agree subdividing is bad. It was the worst thing about Medicare. However, now that Medicare is so popular, not sure how you avoid it.
5) Most people really don’t follow health care. Zombie ideas are rampant. Most people talk about it with little understanding.
6) If you try to pass a big reform that covers everything, it will be attacked for being too big. (The number of pages will be cited over and over as proof of a problem.) If you try to do it in steps, it will be difficult since the first step will get attacked, rather than reformed. This might be different in another political environment.
On the GOP and their plans (there are many), I think I have probably read almost every one of them. They really are not very serious, just rough outlines. Most of them include some variation of what Gustopher has described, plus cutting Medicaid. Since they have never really tried to pass a plan it will be difficult for them.
Steve
Steve:
1) Yep. I know that as well as anybody. It’s why we only tackle it about once a generation and why it’s important to get it right when we do pull up our socks to tackle it.
2) I think it’s impossible. To do it you’d need to have markets. Nobody really wants that.
3) Yep. One of the things that President Obama and the Pelosi/Reid Congress did right was moving fast. Once the interest groups have been mobilized the odds of getting anything done dwindle to nothing.
4) In many years Medicare is already in the red. It happened to be in the black last year. I’ll be surprised if that repeats itself. Reform is gravely needed and unlikely to be undertaken.
5) I probably know the business of healthcare as well as anybody. Over the years I’ve had as clients just about every kind of entity participating: physicians, group practices, labs, hospitals, pharmaceutical companies, medical equipment manufacturers, insurance companies, state governments. Have I left anybody out? Only the Medicare system itself as well as I can tell. Necessarily I’ve come to understand how those participants see their businesses. If I don’t think we can accomplish what we need to within the framework of markets, at least it’s an informed guess.
Medicaid is more popular with many people then healthcare.gov marketplace policies. I believe Medicaid is also cheaper.
Some predicted many employers would cut health benefits when Obamacare went into effect. I don’t think this has happened.
Relying on Gov IT to deliver on time and at high quality is a mugs game
CuriousOnlooker:
The stories I could tell!
Mercer-Medicaid is cheaper than Medicare and early all private insurers. AFAICT, it is not very popular. That said, it is the single largest source, from memory, of funding for long term care for older people. If that goes away I could see some pushback. The GOP is always pushing for broad cuts, block grants, but will be interested to see what states do. Old people vote more reliably than any other group, so if they keep long term instant, who do they cut? About 1/3 of the remaining is for pregnant mothers and the other 1/3 for children. (The actual amount spent on lazy, no good, poor adults who just don’t want to work and sit in the wagon is pretty trivial.)
Steve