Suggestions for Republicans (and Democrats) on how to Fix ObamaCare
Below is an explanation of what is wrong with ObamaCare along with a large collection of centered suggestions for how to fix it.
To keep my words and position authentic, I am writing this from my personal progressive centrist viewpoint (a viewpoint that errs liberal in some respects, yet truly favors aspects of both current parties.)
The primary goal is to give insight to people who don’t share my politics. The secondary goal is to offer my insight to anyone interested as someone who has spent years researching healthcare with a focus on the ACA.
Below is a summary of ObamaCare’s sticking points, a summary of some general problems in healthcare, and a number of workable centered solutions we at ObamaCareFacts.com have devised over the years.
In other words, this page doubles as a resource for “what is wrong with ObamaCare and how do we fix it?”
We have been writing about how to fix ObamaCare for a while now, and this week, with Trump’s first 100 coming to a close and with talks of an AHCA revival, I feel it makes sense to present a summary of all those past ideas.
My hope is that someone on the Trump team or the Freedom Caucus (or another such group) will have an “Ah, ha” moment and realize that the best way forward is one of combining great ideas from across party lines, not one of compromising between Republican factions in time for Trump to add “healthcare” to his check list.
In many ways, the mistake Democrats made was trying to check “healthcare” off the list due to public demand, rather than taking the time that was needed to really get the right plan out there.
Sometimes it can seem like compromising with a figure like Sen. Ben Nelson of Nebraska is the best bet… but honestly, that isn’t what history shows me. Anyway, let us get right to the advice.
SHORT RANT: George Washington passed one of the first mandates back in 1792, now 200-and-some-odd years later, instead of seeking universal coverage, we are still debating if mandates are Constitutional or if healthcare is a right. That makes us look bad. We are so caught up in Democrats vs. Republicans in America that it times seems that we are forgetting about the people and our international image. Below I explain how to not make us look bad and how to ensure universal healthcare, all while maximizing the benefits of the market-based system.
The Advice: How to Fix ObamaCare’s Sticking Points Via a Mixed-Market Solution that Retains Quality and Profits
I don’t have one suggestion; I have countless suggestions.
Essentially I have more than a single bill worth of suggestions with so many solutions that they can’t all be implemented (as I often solve the same problem multiple ways).
Thus, I’m going to offer very general details, and then offer links to in-depth articles that explain each plank. I’m not holding back punches, so forgive any explicit bias.
- Fix ObamaCare’s Sticking Points. The most absurd thing about the past 7 years is that no one has sought to fix any real ObamaCare sticking points. The family glitch comes to mind, but there are countless other examples. The citizens know what isn’t working, but I have this sinking feeling in my gut that politicians do not. The AHCA was, if we are honest, just Ryan’s plan from 2012 (called the Better Way plan in recent years). It is almost like ALEC wrote that bill, it doesn’t fix any sticking points aside bringing down premium costs, but it zeros in on taxes like a hawk (it shows me experts looked at the economics, but not at the needs of citizens). If you listen close, people are more upset about deductibles than premiums, and the AHCA increases out-of-pocket costs. You can frame it however you want (you can tell me its only “phase 1”), but people are going to feel the effects, right? So I mean, I don’t see how passing tax breaks while addressing almost no sticking points works? The lack of an earnest effort to address the sticking points is an insult of the highest order to the people, even if they never fully get what happened, it will remain fact for the historians to see. SEE ObamaCare’s Sticking Points.
- Seek universal coverage (if not “Single Payer” specifically). Right now we debate if healthcare is a right or not. This is a conversation that is had in the U.S., but not in most of the other developed countries around the world. You can say “it isn’t the same because America is better or bigger,” but we all know that is a talking point. We have 50 states that are small enough to make single payer work. Medicare is single payer, and the care that privately insurance provides is only “better” if you can afford it and go to the right specialist. The argument over whether or not healthcare is a human right makes us look like cavemen on the world stage. It is insulting yes, but it is also a national security hazard with economic implications. Image is important; we set standards as a superpower, or at least we should be doing so. We have to offer everyone at least something to remedy this. Even offering junk insurance with basic essential care is better than offering nothing. In 50 years, when they build a monument, there will be no monument that says “they lowered taxes on the rich and left 52 million without coverage; God bless supply side.” Lincoln gets a monument, not Andrew Johnson. We know Trump wants a monument, there is zero chance he gets any support with a plan that doesn’t seek universal coverage. SEE The Conservative Principles and Universal Healthcare.
- Allow for state-based waivers. The 1332 and 1115 waivers are the last bastion of hope for many Berniecrats and progressives. These waivers allow for states to come up with their own solutions and may even result in excellent plans like HIP 2.0. If these are taken away or restricted, it does almost nothing for Trump’s base. As an aside, I’ve never heard him mention them. It will sting progressives and be remembered as the time the GOP decided states’ rights didn’t matter unless it was something that mattered to them. We know folks like Sessions used to be Solid South Democrats. Today that has changed, but one has to think the southern conservatives would have at least brought their values with them. SEE: State-Based ObamaCare Alternative – Sec. 1332. Waiver for State innovation. TIP: If state-based solutions are sought, but that is used as a cover for defunding programs at a state level, that undoes most of the good. Still, even that low-blow is better than a bad federal solution. This goes for block-grants and everything else that is “a states’ rights to not offer rights and liberties.” We never did all agree on what states rights meant, but we have always been correct in respecting federalism. Let’s not drop the ball now.
- Consider a public network and public option. Real capitalism and the real free-market demand, by definition, maximum participation (it is the democracy of the market that makes it free, not the ability of oligarchs to exploit labor). Our current system is essentially a state-controlled mixed-market wrought with mechanisms that distort prices. One way to make supply side work is by keeping public and private separate. If we had a public option and a state-and-federal-funded public network, those with more money and jobs could buy private insurance and seek private care, and everyone else would have a fallback. This would be amazing for job creation and would allow for the private and public markets to compete. It would also allow for low-cost insurance plans that covered say “just non-essential” or “only essential.” The free market is not about maximizing profits or government revenue; it is about people voting with their dollars. Healthcare is not about profit at its core; it is about care. This way of mixing the market ensures the market and healthcare. SEE a Nationwide Non-Profit Public Health Network.
- To be clear, we need at least basic catastrophic coverage for all but pairing that with an HSA (like Pence’s Power Account) could really bring all this together. If you take all the above ideas, combine them, then add a Power Account or HSA (a mix of what Ryan wants for HSAs and what Pence’s HIP 2.0 does), then we have a winning combination. Essentially we offer tax credits and tax breaks to fill the HSA (which could work many different ways), then people use their dollars for non-essential care (no one shops for care in an emergency). This ensures the market system works, and as a giant bonus, it makes every American an investor and capitalist. That is a real capitalist solution, a real Republican solution, and a real Democratic solution. When we respect principles, and when we seek universal coverage and capitalism in a market system, we are all but ensured a system that makes our neighbors jealous. To have so many Americans jealous of our neighbors is an insult to our national pride. SEE A Fix for the ACA (ObamaCare) and An HSA-Eligible Public Option.
At this point, I’ll steer you to other pages I’ve written on the above topics, that will allow the reader to read on and those who have other things to do with their day to bookmark this page and come back later.
See our list of ACA Fixes:
- A Fix for the ACA (ObamaCare).
- Alternatives to the GOP’s Pre-Existing Conditions “Fix”.
- The Problems with the continuous coverage provision.
- How Does ObamaCare Control Costs? Any plan needs cost controls; any plan without them is doomed. I have not heard them mentioned since the ACA was written.
- What Good is Health Insurance You Can’t Use?
- GOP Keeps Trying to Sell Their “Better Way” Plan To Ryan, sorry. To everyone else, this is going to sink you and America. Please don’t send us backwards with promises of phase 3 which is never coming.
- Pros and Cons of the ObamaCare Replacement Plan AKA TrumpCare This piece contains my thoughts about the AHCA.
- Advice on Early April Talks of ObamaCare Replacement.
- The Problem With Block Grants – From a Liberal Perspective Don’t take away our funding and starve us like beasts at a state-level in the name of states’ rights. I can’t tell you how aggressive and obvious that tactic is.
- The House GOP Better Way Plan Explained
- Bernie Sanders Single Payer Overview
Thanks for reading.
Let’s do the right thing by America and show the world that we really are the best.
That means we need a market-based solution to universal healthcare that still delivers great care while retaining profits.
Having your cake and eating it too is hard, but forgetting our honor and duty and failing history by not stepping up to the plate is a fate worse than not having any cake.