Has anyone seen free market Health care reform? I seem to recall a certain political party promising free market health care reform if Donald Trump won the presidency.
Instead they delivered Obamacare Lite.
There are plenty of posts out there summarizing the new GOP American Health Care Act, so I won't rehash them here. This one by Kemberlee Kaye is pretty good.
So let's get right into the objections.
Refundable tax credits are just subsidies by another name. Replacing one entitlement with another is not my definition of "reform."
Paul Ryan is touting his Medicaid cuts, but what he isn't telling you is that he's replacing them with a $100 Billion dollar slush fund for "high risk" state by state insurance pools. Meh. That's a lot of cash that'll be easy pickings for sticky-fingered bureaucrats. And it's not "saving" us anything.
But I could probably live with this plan if that's all it does in "repealing" Obamacare. Alas, the GOP definition of "repeal" must be different from mine, because they're retaining 3 of Obamacare's core provisions.
Lazy slackers will still get to sponge off their parents' insurance up through age 26. Sheesh, by age 26 I owned my first house and wouldn't have dreamed of saddling my parents with my bills. Why are today's twenty-somethings different?
And speaking of saddling someone else with your bills, the ridiculous pre-existing condition mandate remains in force. Look, for the 127,415th time, "insurance" for pre-existing conditions is merely a way for forcing me into paying your bills. When you have a pre-existing condition your costs are known, but Obamacare lite refuses to price your plan accordingly.
Now Paul Ryan et al do make one sop to reality here, if you have a pre-existing condition they require you to maintain continuous coverage or pay a 30% penalty. Which is good as far as it goes, but it still means you're rated as if you're not already sick when you're up for renewal. No actuary in his right mind would sign off on that.
Lastly, and most worrisome, Obamacare Lite preserves the ten minimum essential benefits mandate at the heart of Obamacare's escalating cost structure. So no, we can't choose the plan that's right for us, because every plan will still be required to cover "free" mammograms and birth control, pediatric dental (essential for a 59 year old guy like me!), and a laundry list of feel-good "preventative" services like diet counseling and anti-smoking incentives.
So much for being able to once again purchase a catastrophic care plan and self-insure for the routine stuff.
For that matter Obamacare Lite leaves out all the free-market reforms Republicans have said they wanted. Insurance still won't be sold across state lines, preserving 51 petty fiefdoms and forcing insurers to create a multitude of similar yet distinct plans. There are no association health plans either, which is yet another way for individuals to band together and reduce costs. And nowhere in this bill is any mention of tort reform.
Frankly I don't see this plan reducing my costs at all. It's essentially a full surrender to the forces of permanent liberalism.
I've already shared my skepticism that the bill, which doesn't actually start repealing the major spending provisions of Obamacare until the 2020 presidential election, would actually end up repealing much in practice. But for the sake of argument, let's just assume the plan gets implemented exactly as written.
Supporters of the bill could argue that it does make changes to Obamacare — repealing taxes, reducing spending, and scaling back some mandates and regulations. There are even a few areas in which one could argue the bill moves health policy in a more conservative direction relative to the pre-Obamacare status quo. It provides for expanded health savings accounts and, though it would spend more money than otherwise would have been the case before Obamacare, it would overhaul Medicaid into a program in which states are given a per capita grant and provided the flexibility to run their own programs.
But at the same time, the GOP bill preserves much of the regulatory structure of Obamacare; leaves the bias in favor of employer healthcare largely intact; replaces Obamacare's subsidies with a different subsidy scheme; and still supports higher spending for Medicaid relative to what was the case before Obamacare.
Big Government Republicans are just as execrable as Big Government Democrats. And what we have here is a product of Big Government Republicans.
We can do better.
We must do better.
Repeal Obamacare, in its entirety.
Then, open health care to the free market. Stop treating health insurance
as if it's health care. Trust people to decide what services and
benefits they want to pay for. Free doctors from reams of regulations and
let them practice medicine. It's easy if you try.
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