If you were to collect the threads of Obamacare criticism and try to suture the American health care system, the patient would bleed out. I’ve tried to make sense of the cacophony, but much of it is outrage for the sake of political gain, which merely returns us to the mess that triggered change in the first place.
But let’s say there are conservative critics who genuinely want to replace the Affordable Care Act – rather than just repeal it – with a coherent plan that broadens access and controls costs. First, they better temper their criticism of the current law because some of it could be turned on their plans. Some examples:
There won’t be enough health care providers. I think the market will adjust to increased demand, but if critics aren’t convinced, then what’s the point of expanding access under their plans? Let’s say the elixir of tort reform, selling insurance across state lines (after lifting coverage mandates) and forming high-risk insurance pools to cover the sickest of the sick magically produces affordable coverage for all. Where will the doctors come from?
People are losing their current coverage. Yes, President Barack Obama said people could keep their coverage, and that isn’t going to be the case for a small percentage of the market, because increased coverage standards have caused insurance companies to discontinue some policies. Still, he shouldn’t have said that. You got him. But now what? Good luck devising an alternative plan that doesn’t change anyone’s coverage.
One idea is to take the tax subsidy that encourages employers to provide health care and give it to people to use in the individual market. As younger, healthier workers exit their group plans, insurance companies would have to raise the rates on workplace policies. That would result in employers shifting even more costs to remaining workers or dropping their plans. So we’re right back to some people not being able to hang on to their coverage. Would that still be unacceptable?
Can’t force people to buy something they don’t want. Avik Roy of Forbes is one of the few conservative writers who seem passionate about reform. He has written favorably about the Swiss model, which mixes competition with government controls to produce universal coverage and, in his opinion, the world’s best care. If the United States were to shift to another model, the transition to this one might be the easiest. Switzerland’s costs per person exceed those of most Westernized nations, but they’re still considerably lower than they are here.
However, the country has a mandate to purchase coverage, allows only nonprofit insurers to offer basic plans, standardizes those plans and redistributes the wealth to help the poor. Coming from Obama, this reform would be met with denunciations of “socialism” and “one size fits all.” So why would it be OK if critics of the president’s plan pursued this idea? It’s a valid question, because the Obamacare mandate mirrors that of a plan floated by the conservative Heritage Foundation 20 years ago, and we’ve seen how conservatives have turned on that.
A rejoinder to all of the above is to abandon the government mission of universal care and remain the only modern nation without it. OK, then turn off the crocodile tears about someone losing a policy, because that’s been going on for decades without a decent replacement. And, please, cease the whining about an insufficient website when deep down you’re happy when it fails.
It’s been said that Obama now owns all of health care. Fine. But many critics own what we have now: a system of canceled policies, diminishing coverage and increasing costs that is ravaging budgets and is fatally flawed.
If this isn’t true of you, then I’d like to hear the plan. Just be sure you haven’t boxed yourself in.