The Latest in the Obamacare Saga: Iteration Number x+……

I have refrained from writing about health care recently until I could get a better handle on what would happen.  It seems I now have a better handle–for now at least.  The Senate bill or its iterations was likely doomed to failure for this reason:  There were and are at least three factions at cross-purposes:

  1. Moderate Republicans
  2. Democrats (almost all)
  3. Conservative Republicans

We knew the Democrats would vote more or less as a bloc.  But the problem was the Republicans.  If the bill contained too many conservative elements, the Moderates would vote against it. If it contained too many Moderate elements, the Conservatives would vote against it.  Now we have to define what elements are what.

 

Repealing Obamacare in its entirety is very conservative and drew opposition from Moderates, even when some “sugar” was added to entice them–it only took a couple of no’s.  Keeping Obamacare in its entirety was the default that would occur if a vote couldn’t get support to pass, and it is very liberal.  However, though many Conservatives wanted to see at least most of Obamacare go, they did not have enough support to make it happen without giving something to their Moderate colleagues.  So they lost their votes.  When the “skinny” approach was proposed, there was still too much in it that bothered Moderates, who voted against even that, suspicious that the House would double-deal and the Senate would not follow through with leadership promises.  Now we are back where we began: Obamacare in full force, though how stringently it will be enforced is anybody’s guess (the Obama administration selectively enforced parts).  

The real issue is how to evaluate all this.  I am still convinced that (1) Lisa Murkowski voted against the skinny version because she has grown to hate President Trump (not an altogether irrational position, but not exactly mature either) and (2) if the Senate had the entire good of the nation in mind, instead of narrow interests, it could actually come up with decent legislation that would pass, even with no Democrats, but possibly with a few.  The key is compromise that moves in a positive direction, even though imperfect.  Some Senators have to disabuse themselves of the notion that they can have an ideal, perfect world.  What we want is the “best of all possible worlds.”  

So what should the Senate do?  Come back into session and propose this kind of bill:

  1. Segregate out (wall off) those people who cannot afford insurance and subsidize them from the General Fund separately and not at the expense of the health care system as a whole.  This cannot mean infinite payouts.  It would work something like Medicare or Medicaid–not perfect by any means, but only affecting a relatively small number of people.
  2. For the rest of the population, and even for the poorer, at the same time, create a truly market-driven health care system in which competition is free, across state lines (mandated competition here–no state discretion to prevent it as under the current McCarran Act), regulation of services is minimized to those absolutely necessary, eliminate the taxes, including the Mandate, innovation is encouraged, particularly by just leaving medical care alone to a much greater extent, nudge states to open up medical training to more people and some medical services to different professions (nurses, etc.), allow medical savings accounts, encourage more choice by allowing insurance companies to offer varying plans, etc.
  3. Allow Democrats to suggest amendments, and if they can move us forward without undue compromise, accept some of them.  At any rate, make Democrats have to defend their opposition by giving them an opportunity for “buy-in.”
  4. Pre-existing conditions:  This is still a huge fly in the ointment, but if necessary, give in to cover them, but at the same time, make sure the other cost and competition-enhancing elements are included.  The two must go together.  That way, even covering pre-existing conditions, though not really insurance anymore, does make more sense.

I am sure I missed something, but the reader will get the main point.  Our goal is to shed the terrible Obamacare system with its byzantine regulations and at the same time get a better health care law then we had, even much better, though compromise will be necessary.  I would have to see the particular bill to determine whether too much has been compromised.  But the approach seems worth it.  I still cannot figure what Senators McCain and Paul really want, but I am optimistic (perhaps too much so) that even they would be willing to go a little way.  And on the Democrat side, I think Manchin of West Virginia might come along, and maybe some of his more moderate friends.

In the end one does not have to always be an ideological purist, and in politics in the “trenches” one can seldom afford to be a purist.  Moreover, it is not a compromise of conscience to agree to non-ideal aspects of a proposal that still move the nation in a better direction from where it was.

15 thoughts on “The Latest in the Obamacare Saga: Iteration Number x+……”

  1. “For the rest of the population, and even for the poorer, at the same time, create a truly market-driven health care system in which competition is free, across state lines (mandated competition here–no state discretion to prevent it as under the current McCarran Act), regulation of services is minimized to those absolutely necessary, eliminate the taxes, including the Mandate, innovation is encouraged, particularly by just leaving medical care alone to a much greater extent, nudge states to open up medical training to more people and some medical services to different professions (nurses, etc.), allow medical savings accounts, encourage more choice by allowing insurance companies to offer varying plans, etc.”

    What if the truly poor cannot afford these market-driven plans? And I mean NOW, not years from now, which is how long some of your interesting ideas would take to see results.

    What then? What if they cannot afford the premiums, which would certainly skyrocket?

    Subsidies to help them pay for market-driven plans? Or should we just let them die and let society (and families) deal with the aftermath of unnecessary deaths?

  2. In point one, are you saying that those who are truly poor should still receive Medicaid?

    You do know premiums would certainly rise for many if your ideas were implemented, and that many of those who do not need subsidies to pay for coverage would need them then, right?

  3. If the Mandate is eliminated, as you suggest, what should be done to those who refuse to buy insurance (for themselves and/or for their families) in case of emergencies?

    Should ambulances check for ability to pay before picking up, say, someone who complains of chest pains, or a child in an accident?

    Without the mandate, there are many who would choose not to have insurance, thinking that they do not need it, but when an emergency happens would be unable to afford medical care for themselves or their families. That was one of the reasons for the mandate in the first place, after all.

    What should we do with them? Let them die? Or let them stiff hospitals, especially those in poor, rural areas, thereby hurting the rest of us who pay their bills and choose to be responsible by ensuring ourselves and our families? Those who do not pay drive up prices for the rest of us, certainly.

    The Mandate at least ensured greater responsibility, which to me makes it a conservative idea. The idea that some can game the system (not pay for health insurance, and then not pay hospital bills when they come) is simply bad policy, but perhaps not as bad as letting people just die.

    1. Perhaps allow for a catastrophic insurance that would cover life-saving procedures and emergencies for people who would otherwise not need all-compassing care?

      1. Life saving procedures and emergencies are expensive.

        Any insurance that covers those naturally would be expensive too.

    2. Jeff, the mandate is definitely NOT a conservative idea. Coercion by the State is not conservative.

      1. What you call “coercion by the state,” I call making certain people exercise personal responsibility so they pay into the system they use, and do not steal from more responsible citizens.

        I guess you are fine with subsidizing people who cannot pay their bills after they refuse to buy insurance. That happens all of the time and is a major reason why rural hospitals support the individual mandate. They do not want to close, because if they close, how are residents going to get the emergency health care they need.

        I support personal responsibility. Guess that would make you a supporter of personal irresponsibility.

      2. If you are making someone exercise responsibility, then it is not them taking responsibility, it is the person doing the forcing.

        I get it. I really do. I understand the logic behind the mandate. But that doesn’t mean it is teaching responsibility. In fact, with those who can’t afford it, I believe it teaches just the opposite.

        If John Smith cannot afford insurance, but has to buy it, so the government will then help him pay for it, he becomes dependent on the government. The government assumes responsibility for him, he is not taking it for himself. In fact, chances are he will then expect the government to step in and help him manage other aspects of his life as well.

        I am not fine with subsidizing people who cannot pay their bills after they refuse to buy insurance. I am fine with subsidizing people who want insurance but through no fault of their own cannot afford it.

        My preferred solution would be to let those who do not responsibly prepare actually deal with the consequences of their actions in some manner. Of course I am NOT suggesting we just let them hang out to dry, not with heathcare and potentially life and death situations, but we need to find a way other than coercion by the State by which a person can proactively pay off in some manner the expenses they owe.

        But suffice it to say, opposing the mandate does not make one a supporter of irresponsibility. Such rhetoric merely continues your usual pattern of applying derogatory labels to those who disagree with your preferred policies.

  4. Dr. Clauson,

    In my opinion, the problem addressed in #1 should have been the original approach of the Democrats back in 2009. There was 30 some million uninsured (I believe that was the figure) that Obamacare was supposed to help. They should have crafted a narrowly tailored policy that helped those who needed it and left everything else mostly alone.

    I do have a question: What role do you see the costs of drugs and medicines playing in overall healthcare costs and what policies would you recommend to control drug costs without unnecessary meddling in the market?

    1. I do not believe that an idea is automatically conservative just because a conservative proposed it. I simply do not view the idea of a government mandate as being conservative. That does not mean that some conservatives, if they choose, cannot support an idea or two that is not conservative. I do not expect every conservative to be 100% conservative all the time on every issue and neither would I expect a liberal to be 100% liberal on every issue.

      1. I see your point.

        I assume you also know that “conservative” is completely a human construct. Its meaning changes all of the time. To me it is almost a meaningless word.

        Same with “liberal.”

        I myself do not like using terms like “conservative” and “liberal.” I don’t care if an idea is conservative or liberal. I care if it makes sense, is consistent with experience, and gets results.

        Without the individual mandate that requires healthy people to buy insurance, prices for those who are less healthy may well be out of the price range for many, and the result may well be a “death spiral.” The “skinny repeal” could well have done that. Thank goodness for John McCain, who has more courage in his pinky finger than our president has in his entire body.

  5. “My preferred solution would be to let those who do not responsibly prepare actually deal with the consequences of their actions in some manner. Of course I am NOT suggesting we just let them hang out to dry, not with heathcare and potentially life and death situations, but we need to find a way other than coercion by the State by which a person can proactively pay off in some manner the expenses they owe.”

    I appreciate your response, but it is problematic.

    First, what about the common situation in which the father (often the breadwinner) decides for his family that he is not going to buy insurance, and then the wife or one of the children gets sick? They are the victims here, and yet you would want them to suffer the consequences of someone else’s actions? That is cruel and, I would argue, not what a Christian should do.

    Proactive pay? What are hospitals supposed to do until then? Pay their expenses in IOUs?

    I KNOW people who choose not to get insurance, have gotten sick, and then have stiffed health care providers. And then brag about it. Without the individual mandate, people like that will keep getting away with irresponsible behavior.

    If we have laws against theft, why shouldn’t they be applied to those who steal health care?

    1. I know my response has lots of issues that need addressing. I do not deny that. Do I know what the answers are to those question? No, I will not pretend to.

      1. Thank you for your honesty.

        Health care is hard. Easy answers are not to be found.

        I hope this country gets it right.

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