• Would repeal be healthy?

    Uwe Reinhardt thinks repeal of the ACA would be good.

    Because then you have a clean slate. You could say [to Republicans], “Okay guys, now the show is yours. Tell us what you’re going to do. Here’s a waitress, she’s got kids, she can’t afford insurance. What are you going to do about her?” And I think it would be a healthy thing to see happen.

    I disagree. This perspective presumes Republicans would be as willing to take on politically challenging issues as Democrats were in the 111th Congress. The level of responsibility, not to mention alignment of the political planets, required to pass the ACA is rare. Democrats may not demonstrate it again for a long time either. Even if they did, the opportunity for comprehensive reform may not coincide. That door doesn’t open frequently. When it does open, will Republicans walk through it? Would Democrats, again? I’m not so sure.

    This country has been struggling with health care for over a century. The issues debated in the run-up to passage of the ACA and since are not new. All other wealthy, industrialized nations have settled many of them, some long ago. If the ACA were to be repealed–and it won’t be–there will be many more years of suffering and struggle. I do not welcome it. On some points, we’ve debated long enough.

    My concern about all the talk of repeal is not that it will happen but that it will encourage some states to drag their feet. It will embolden interest groups to seek regulation more favorable to them and less so for individual, population, and fiscal health. Most importantly, it will detract from the real task at hand, making sure the insurance market reforms work and, just as importantly, making sure the cost controls in the law are implemented. They may be insufficient, but they’re more than we had before passage.

    I think repeal would be tragic. There would be health consequences I do not welcome. There would be little promise of future cost control. And it would demonstrate that this country cannot move forward on important issues.

    In his interview with the Fiscal Times Reinhardt says many other things worth reading and contemplating. I agree with many of them. But about repeal being a healthy development, I do not.

    • I think Reinhardt has a different view of the Republican Party than I do. I just dont see them willing to spend 13 months on a health care bill. It is not a subject they have ever embraced. If you look at state governments that they control, it is not much of an issue, other than just keeping everyone off Medicaid by setting the eligibility rate cutoffs at low incomes. If he were correct, and they would actually deal with the issue, he might actually be right. In the short run more might suffer, but in the long run we would have a system that would not suffer from constant sabotage attempts by one party. He is correct about our governance model methinks.

      I did like this a lot.

      “The private sector is not very effective in negotiating prices. The public sector can just put a lid on it and say, “That’s all we’re paying.” The private sector is the inflationary component of health care, not Medicare or Medicaid. Medicare and Medicaid haven’t grown faster, even though they deal with the older population. It’s the private sector that doesn’t know how to control costs.”


    • Dr. Frakt,

      I think that you will find this article interesting. It is about the legal challenges to PPACA