Saturday, July 29, 2017

The Health Care Debate Gets Buried in the Swamp

Senator John McCain (Getty Images)

John McCain executed his sweet revenge on Donald Trump Thursday night by killing a shell health care bill written as part of the anti-Obamacare effort.  So called “skinny repeal” was the cancellation of the medical device excise tax that was passed with the Affordable Care Act.  In theory, all Republicans should express perfect unanimity over resecting a law that both puts a tax where there was none and stifles innovation in a technology field that makes lives better.  But, a Senator from a state that is totally dependent on Medicaid (Murkowski - Alaska) and a Democrat in Republicans’ clothing (Collins – Maine) apparently thought hanging together wasn’t the way to go with Mitch McConnell’s current strategy.

As did John McCain.  Two weeks ago, the Arizona Senator underwent a routine surgery in Phoenix to remove a blood clot from above his left eye.  A pathology report of this clot revealed evidence of glioblastoma, which is an aggressive brain cancer.  Why not slow down? was the gist of his speech in favor of moving ahead with debate earlier this week.  Slowing down would also prolong his torture of our instant gratification President, a man who insulted the former Vietnam POW for being shot down and captured.  When skinny-repeal died on the table, so did Trump’s campaign hype that the GOP would repeal Obamacare.  I promise you, this was as much in the Senator’s mind when he cast his vote at midnight yesterday morning.

As tragic as McCain’s revenge vote was, the greater crime in the Obamacare repeal movement has been that Republicans generally aren’t being true to themselves - even the so-called "heroic" ones like Cruz, Lee, Paul, etc.  This is because the President is not a true conservative, and cannot guide the members of the House and Senate accordingly.  House Speaker Paul Ryan is the closest thing we have to a market-oriented health care policy wonk on the repeal effort, but he is trapped in being from a state/district that ultimately thinks it needs some type of guaranteed health coverage.  As a result, his creativity is limited to inside-the-box thinking.

Republicans’ only hope at truly reforming health care, which Senator McCain yesterday claimed was his reasoning behind his no-vote (subliminal message: yeah, whatever), is to stop, yes, but more importantly, take a deep breath and remember their conservatism.  Here are the key ideas to remember, in case their political egos have also put their ideology on life support:

  1. De-couple health insurance from employment.  There are multiple ways to do this, including, if necessary, putting a 150% tax on corporations that offer it as part of a cafeteria plan, which will disincentivize.  This is arguably the second-biggest factor as to why we have such high premiums and therefore a lack of coverage among those who are younger and poorer.

    I don’t have the space here to elaborate, but think of it as car insurance.  Our car insurance is affordable because we have to go out in the marketplace and get it; most employers only offer modest discounts if it is any kind of work benefit.  Health insurance is high because insurers know that big companies have the money to pay the premiums, hence the micro-inflation in prices.
  2. Raise the enrollment age of Medicare to 72.  Americans, for the most part, are living longer because of better information about diet and exercise and market-led pharmaceutical therapies.  They are also in the workforce longer.  Put this population back into the larger coverage pool, and more payers will reduce premium prices.
  3. At the same time, take those more aged individuals with existing conditions and put them in either a regional or state-organized risk pool.  Certainly, more work needs to be done with risk pools to make them function correctly, but this is what states are for.  Let them use trial and error, if need be.
  4. Put a DNR on Medicaid – DO NOT EXPAND IT!  Move all the poor people into some type of CHIP program, and get them to start paying SOMETHING.  This must occur – there will be no modification of consumer behavior until they are putting money toward coverage of their families instead of into junk food and drugs.

    There needs to be a tax credit for long term care policies.  The biggest cost to state Medicaid programs are nursing homes.  If an employer wants to offer a low-cost benefit to its workers that’s health-related, make it this one!  Long term care policies work and will force nursing homes to adapt to market forces instead of walking up and down the halls of state capitols with their hands out.

These are just some of the core principles that Republicans need to “slow down” with and use to grade every other idea they have.  Of course, the Obamacare subsidies need a deep hole to be tossed into; it is this part of the ACA that many Republicans are hoping will tank the program.  But this is a game of chicken that will result in band-aid spending ad nauseum courtesy of the Democrats.  And obviously, the mandates of coverage must end – these are market perversions that will not make anyone “healthier.”  But above all, there has to be a return to smart, principled thinking, not just this partisan, that’s-a-stupid-idea attitude.

If not, all we get it is revenge drama and the pettiness writ-large that is refilling the swamp faster than it can be drained.

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