November 18, 2017 - 9:00 pm
President Donald Trump’s temerity-driven executive order ceasing subsidy payments to health insurers prompted a rare bipartisan response in the Senate proposing a temporary patch for a law — Obamacare — that is hemorrhaging billions of dollars. The proposal would continue the cost-sharing reduction subsidies for two additional years. But to what end? Even Democrats are no longer able to muster any real enthusiasm for Obamacare.
What these behaviors indicate is the inability of Republicans to present an alternative to the president that maintains coverage for current Obamacare recipients while creating a market-based solution that offers the last best hope to control health care costs. Republicans forfeited their advantage to Democrats, who have now become so emboldened that they are openly preening over the prospect of “Medicare for all” as the latest cure-all.
You would think that they would, at least, have the courtesy to wait until Obamacare has had its last rites administered before introducing a sure killer into the private health care system.
If the health care law were a patient, the “doctors” in the Senate are treating only the symptoms of the disease while ignoring its cause. But there is a Reaganesque, pragmatic solution, and one has to wonder why the Republican leadership has not suggested it to President Trump, who clearly is desperate to sign a health care reform bill — even a bad one.
I am sympathetic to those with serious health issues that previously precluded affordable coverage. Many were covered through an employer-based plan, which was lost when they became unemployed. Obamacare did reverse the collateral damage done to those individuals — to the disadvantage of the healthy majority. But providing subsidies does not address the absence of competitive rates for healthy individuals not eligible for those subsidies. If continued, this endeavor has the markings of becoming the most egregious boondoggle in the history of health care.
Meanwhile, progressives dream of single-payer. But I also have a dream.
I dream of an individual exchange rising out of Obamacare but without its burdensome regulations, which restrict purchasers to nothing but over-bloated policies. The key is to allow patients to choose, within limits, policies that fit individual needs. Over time, with the excitement generated by this new framework, premiums and deductibles will become dramatically lower for healthy individuals. In my view, so low that some will choose to purchase their own policies rather than become dependant on employer-based plans, which have done nothing to reduce health care costs.
Subsidies would necessarily remain for low-income Americans. But the massive, untapped pool of potential enrollees will make this exchange a success if it meets the needs of patients, not bureaucrats.
The administrative transfer of Medicaid to the states, where their efficiency will better control long-term costs, is also necessary but without any current recipient losing coverage. The simplest way to provide insurance for those with serious medical conditions would be to place those in need on Medicaid with transfer to an employer-based plan should they gain access to one. To neutralize the politics of envy, retention of the investment tax on high earners should be perpetuated for big-picture considerations.
Without bipartisan support, sustainable health care reform is illusory. Even leftists will be hard-pressed not to acknowledge that this plan improves the survivability of Obamacare. There are Democrats in the Senate who understand that long-term political success depends on ameliorating, not propping up, a failed policy. For that reason, if this plan is adopted, those Democrats would be foolish to filibuster at risk to their own electoral lives.
If we don’t allow an individual exchange the opportunity to bring down coverage costs, we might as well become resigned to an incremental pathway toward “Medicare for all,” which would eventually become financially unsustainable. And after the fall comes the health care system that progressives have dreamed of and most Americans will surely mourn.
Those without powerful voices who did not materially benefit from Obamacare are watching. Donald Trump could flip public disdain into a “Saratoga moment.” By rewarding younger voters with access to quality, affordable health insurance under control of the individual, Mr. Trump may even transform some members of the Obama coalition into capitalists.
Robert Chancellor, a medical doctor, writes from Las Vegas.