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The Affordable Care Act has serious problems, but Republicans seem to forget that the pre-Obamacare status quo was unacceptable, too. Tearing down a bad law is a great thing to do, but not until we’ve built something better in its place.
“Who knew healthcare could be so hard?” President Trump once asked.
The fact is, if it weren’t hard, there’d be a workable solution by now. It’s sad that our national health care discussion, along with everything else, quickly dissolves into a partisan morass, but it would be nice if people could step away from the bickering and look at the bigger picture, which includes the following elements:
1. The pre-Obamacare status quo was unacceptable.
In their opposition to Obama’s overreach, Republicans have not offered any substantive alternatives and have instead become the de facto defenders of the pre-ACA health care status quo, which was unsustainably expensive, ridiculously bureaucratic, and allowed too many people to fall through the cracks. There are certain conservative solutions that need to be part of the mix – tort reform, primarily, in order to reduce obscene malpractice insurance costs – but both sides of the aisle have to acknowledge and address that there are fundamental structural problems with the system, and it’s not enough just to oppose what Obama did – one needs to offer something constructive in its place.
2. Even before Obamacare, we had a warped form of universal health care in the United States.
Granted, it was the most expensive, convoluted, and inefficient universal health care system in the industrialized world, but the fact remains that we don’t allow American citizens to die in the street for lack of health care. Emergency rooms and hospitals are required by law to treat all patients, regardless of their ability to pay.
Opponents of the flawed Obama solution ignore the fact that the current system already has enormous hidden costs as insurance holders shell out for higher premiums to compensate for the costs of covering the indigent. In addition, there is no political will to create a system where health care becomes 100% “market-driven,” so that if you can’t afford it, you can’t get it. Consequently, if we’re going to provide universal health care, we ought to figure out how to pragmatically provide it at a reasonable cost rather than pretend we’re not doing it.
3. It is impossible to get insurance companies to overlook pre-existing conditions without an insurance mandate.
Since the individual mandate is the bedrock of the conservative case against Obamacare, conservatives who once championed such a thing as a viable alternative to a single-payer system have suddenly – and relatively recently – decided that this is the most hideous aspect of the law, the death of freedom, and the rise of Big Brother.
Now there is a legitimate argument as to whether or not this should be a federal responsibility, but there is no legitimate argument that maintains that an insurance pool can survive if people can wait until they get sick before they join it. Without an individual mandate, at least on a state level, the government will be forced to provide subsidized coverage to the chronically ill, which will likely be more expensive than a mandate would be.
This is not an endorsement of a mandate, but rather recognition of a mathematical reality. As of now, there are three approaches to providing universal coverage – Medicaid, an insurance mandate, or the kind of leaky-bucket emergency room approach that was the standard before the ACA. There is also the option of letting the poor suffer and die for lack of coverage, which, for most Americans, is not an acceptable option.
4. We need to look closely at catastrophic coverage and medical savings accounts.
Insurance should cover catastrophes, not maintenance. Your car insurance will replace an engine and an auto body that are destroyed in a wreck, but it doesn’t reimburse you for gasoline and oil changes. Health insurance should follow the same model. In addition, tax incentives need to be shifted in order to separate medical benefits from the employer, and insurance companies need to be given the freedom to do business across state lines.
None of these reforms will fix the problem entirely, and if there were an easy way to do it, it would already be done. But as conservatives get excited about tearing down a bad law, they need to recognize that this marks the beginning, not the end. It’s time to start building something better in its place.
In addition, any law Congress passes needs to fully apply to members of Congress. Lawmakers will be much less willing to pass a bad law if they have to live under it, too.