Sunday, March 26, 2017

On the failure of AHCA

The American Health Care Act (AHCA) was pulled from consideration by Paul Ryan.  When Ryan announced he was pulling it, Heartland Institute immediately asked for comments from its experts for a press release.  I'm on the list and had a free moment to send some comments.

Here's the press release.  It contains my thoughts, as well as those of four others, and all are worth reading.  Mine are the last. (They saved the best for last? Buried the worst at the bottom? Either way, at least I'm not mediocre... hahaha!)

However, they did cut my submission, perhaps for length, or relevance, or to help me avoid mediocrity, or for some other reason.  Probably length.  Regardless, here is my original set of comments...unexpurgated!  (It's the penultimate paragraph that was cut.)
Comment from Steele:

The decision by Paul Ryan to pull the AHCA bill is a good one, but it must be followed by developing a much better bill.  The AHCA really is not a repeal of the ACA but a modification, and not a very deep one.  It left untouched some of the deepest flaws of ACA.  For example, there's the prohibition on taking pre-existing conditions into account  when an uninsured person decides to buy insurance.  There's also the absence of annual and lifetime caps on payouts.  Never mind whether these are "fair" or liked by the many among the public, together these guarantee that insurance costs will rise uncontrollably and that insurance programs will eventually collapse from adverse selection.  The comprehensive nature of coverage simply adds to the problem.

One of the main drivers of increasing health care costs is insurance.  Having all purchases of health care handled through insurance means patients have no way to make decisions about the benefits and costs of care, and no way to shop for good deals in health care.  Decision making must be returned to the patient, on a free market for health care services.  This cannot happen under schemes like ACA and AHCA, and requires that the Republicans rethink the entire approach to reform.

The notion that AHCA is just the first of three phases is specious.  The Phase 2 regulatory changes from HHS are at best temporary stopgaps.  Phase 3, additional changes made in a bill that can garner 60 Senate votes, is a pipe dream, given the current Senate.   And none of this addresses the growing crises with Medicaid and Medicare.  Speaker Ryan and the GOP need to simply get one good bill together that  genuinely repeals ACA and gets us to a free market in health care.  This will take careful thought and great determination, and they should simply get on with it.

One thing that I find disturbing is that the Republican leadership seems more beholden to the Senate filibuster rule than to the liberty of the American people, the Constitution, or the quality and affordability of our health care.  The Democrats are behaving as complete obstructionists, and should they return to power with the basic framework of Obamacare in place, they'll use it to take us all the way to fully socialized medicine. The Republicans should simply acknowledge this and get to work dismantling government intervention in health care.

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