Well, it finally happened. We now have the long-awaited Republican plan to replace the hated Obamacare with something better. They had eight years to come up with something, and after so much building anticipation, that something is here.
And this steaming pile of garbage is what they came up with?
Republicans have been correctly decrying the Affordable Care Act since its passage. It is bloated, it is expensive, it has resulted in higher premiums, skyrocketing deductibles, more out-of-pocket costs, and declining health care quality.
The problem, it seems, is that they — Washington Beltway Republicans — were never serious about developing a counter proposal that tackled the big question of health care in America.
Rather, they were content accumulating the political benefits of opposing an expensive and unpopular government boondoggle, without doing the hard work of developing a revolutionary idea of their own and unifying behind it.
Sadly, if the law isn’t dealt with now, it never will be.
Unfortunately, the initial plan pushed by Speaker Ryan and endorsed by President Trump is a gutless, milquetoast proposal that not only doesn’t repeal Obamacare, but actually reinforces and strengthens most if its core elements.
The failure of the bill is systemic, and irredeemable.
It gives, for example, permanent life to the ACA’s disastrous expansion of Medicaid, which represents the most overt attempt to federalize health care delivery and draw more people into government-run insurance programs.
Indeed, the bill does not stop new states from expanding Medicaid, and does not immediately freeze enrollment in existing expansions. It fails to repeal most of the costly mandates and insurance regulations driving up premiums and deductibles.
And the bill replaces Obamacare’s subsidy scheme with a new costly federal entitlement in the form of a refundable tax credit. Worse, it does not repeal most of the regulations that have helped drive up the cost of insurance nationwide.
Sure, it repeals the individual mandate (kind of) — the bill replaces the mandate with a 30 percent premium penalty for anyone, regardless of health, who fails to maintain continuous insurance coverage.
Sure it makes some really good changes to the tax code, such as significantly beefing up the law’s treatment of health savings accounts. Sure it does eliminate a lot of taxes that helped fund Obamacare.
But while those are all nice, they also represent changes on the margins.
What conservatives needed to do is start at the beginning. Rather than obsessing about what part of Obamacare to keep, what to repeal, what to change, and how to nibble at the edges of reform, it needed to ask itself a very simple question.
If you were designing a health-care system from scratch, what would it look like?
There is an old saying in project management. You can do something good, you can do it cheap, and you can do it fast. But you can only pick two. Good and fast, but not cheap. Fast and cheap, but not good. Cheap and good, but not fast.
With health care, we can choose between universal coverage, on-demand health care with minimal wait times, exceptional quality, equal treatment of all citizens regardless of health care consumption, and an overall affordable cost.
You can only pick some of those, not all.
So what kind of system do Republicans want? What do they believe in? What would they design if there were currently no system in place? What problem do you want to address? What do you want to do to health care?
The president of an organization that helps people and companies navigate the health-care system recently recounted a story to me, highlighting a cancer patient who was getting chemotherapy at an eastern Maine hospital that was costing roughly $70,000 per month. That exact same treatment one hour down the road at another hospital cost $35,000, exactly half.
This is the system as it exists today, built on opaque health care delivery. The government, insurers, hospitals and armies of bureaucrats hide prices and discourage shopping for care, so costs skyrocket with no accountability.
The Republican plan should have identified this problem, and cut the government out of the system as much as possible. Introduce radical transparency. Incentivize market competition in health care. Promote and encourage the Direct Primary Care industry. Reform insurance to allow it to tailor plans to people to protect them from catastrophic cost, not subsidize every health care decision. Reserve the government safety net for the poor and uninsurable only, and get entirely out of the rest.
That is the bill they should have proposed, not that any of them had the guts to actually do it.