It’s not rocket science (it’s tweaks to Obamacare)

Nice post from Kevin Drum on what is necessary to actually improve the ACA.  It’s really not that hard.  If Republicans were not hell-bent on “repeal and replace!” but on actually fixing what ails Obamacare and creating more sustainable health care (that follows basic conservative tenets) they would just do these things.  Drum:

Mine is a nice, simple, 3-step plan:

  1. Enforce the individual mandate and increase the penalty to 3.5 percent of income.
  2. Increase subsidies by 20 percent and extend them to 6x the poverty level.
  3. In areas where there are fewer than two insurers participating in the exchanges, make Medicaid available for the price of an average Bronze plan.

This is not a wish list of everything that would make Obamacare better. It’s a minimum set of proposals that would keep Obamacare stable, reduce premiums, and fix its worst problems. That’s it…

Of course, my plan would cost more. My horseback guess is that it would cost an additional $25 billion per year or so. Obamacare is currently under its initial budget projections, and this would put it a little over. That means no tax cut for the rich, which presumably makes it a nonstarter for Republicans. On the bright side, I don’t see any reason why we couldn’t include a few Republican ideas in this package too. More generous tax treatment of HSAs, more Medicaid flexibility for states, etc.

This is all pie in the sky. But I’m pretty sure that it would work once the details were filled in. This isn’t rocket science.

Within the parts I cut out, Drum explains how this would work.  I know enough health care policy myself to say, yes, it very likely would.  Of course, in a sane political system we would have done these things years ago.  In our system, alas, Republicans are opposed because 1) it spends more money to help poor and working people, and 2) Democrats like it.

And, while I’m at it, Krugman on the lying Republicans are using to defend their plan:

Consider, in particular, Republican leaders’ strategy on health care. At this point, everything they say involves either demonstrably dishonest claims about Obamacare or wild misrepresentations of their proposed replacement, which would — surprise — cut taxes for the rich while inflicting harsh punishment on the poor and working class, including millions of Trump supporters. In fact, there’s so much deception that I can’t cover it all. But here are a few low points…

Second, he points to the 28 million U.S. residents who remain uninsured as if this were some huge, unanticipated failure. But nobody expected Obamacare to cover everyone; indeed, the Congressional Budget Office always projectedthat more than 20 million people would, for various reasons, be left out. And you have to wonder how Price can look himself in the mirror after condemning the A.C.A. for missing some people when his own party’s plans would vastly increase the number of uninsured.

Which brings us to Republicans’ efforts to obscure the nature of their own plans.

The main story here is very simple: In order to free up money for tax cuts, G.O.P. plans would drastically cut Medicaid spending relative to current law, and they would also cut insurance subsidies, making private insurance unaffordable for many people not eligible for Medicaid.

Republicans could try to make a case for this policy shift; they could try to explain why tax cuts for a wealthy few are more important than health care for tens of millions. Instead, however, they’re engaging in shameless denial…

O.K., so the selling of Trumpcare is deeply dishonest. But isn’t that what politics is always like? No. Political spin used to have its limits: Politicians who wanted to be taken seriously wouldn’t go around claiming that up is down and black is white.

Yet today’s Republicans hardly ever do anything else. It’s not just Donald Trump: The whole G.O.P. has become a post-truth party. [emphasis mine]


About Steve Greene
Professor of Political Science at NC State

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