The ObamaCare bill was flawed, its adoption was flawed, its implementation was flawed, and its result was flawed. It is teetering on a precipice of unsustainable rising cost and unacceptable declining choices.
Its complexity is at the core of its failure. Being all things to all people in complex schemes with untold numbers of variables is a common formula for failure - especially when done without transparency and in a highly partisan manner.
President Obama would have been better off to simply have called for an expansion of Medicaid. He would have achieved nearly the same reduction in the uninsured without the negative consequences of ObamaCare.
The Republican Party has called for the repeal and replacement of ObamaCare since its inception. The Republican reform risks failure for similar reasons to Obamacare - complexity and potentially partisan passage.
Serious work on how exactly to do that has largely fallen to House Speaker Paul Ryan. But there is not unanimity in the Republican Party and competing plans are proposed in the House of Representatives. In the Senate, Rand Paul and others are critical of Ryan’s proposal and have offered an alternative as well.
President Trump is riding the fence at this point allowing Congressional Republicans to battle, but ultimately he probably sees himself as the arbiter of a final deal.
The Democratic minority, under the leadership of Representative Nancy Pelosi and Senator Chuck Schumer have opted to simply obstruct process and resist any change – thus making them near irrelevant in the process and outcome.
Unfortunately, the debate is once again about reform – not change – and is more about politics than health.
The Democrats need to stop defending a failed policy – ObamaCare. They should say clearly and consistently –we believe there should be national healthcare. The Republicans should say clearly and consistently – we believe that market forces provide for better healthcare outcomes. Then debate the merits and develop a consensus.
Frankly, it seems that a compromise position is possible that could satisfy most Americans that can accommodate the principles of the two parties in a uniquely American model that integrates the public and private.
Every American citizen and legal resident should receive government provided catastrophic care akin to Medicare part A (e.g. hospitalization, non-elective surgery, associated care and rehabilitation) to ensure everyone has access to essential care and no one suffers economic collapse from illness, injury or disease.
Government already pays nearly 50% of all healthcare expenditures. Medicare, Medicaid, SCHIP, VA, and Tricare would be subsumed by the new system. The VA system would specialize once again (e.g. amputation, burn treatment, and PTSD). Medicare would be authorized to negotiate drug prices (one of the highest costs of healthcare) to lower costs.
The remainder of healthcare beyond catastrophic care would fall in the private marketplace to maintain competition and encourage innovation. Employers and individuals could obtain supplemental insurance of all ranges to suit their needs and budgets as well as health savings accounts. Policies could be sold across state lines. Vouchers (rather than tax credits) could be used by special populations (e.g. military dependents, retirees and disabled veterans, low income workers and retirees, etc.) to aid them in procuring supplemental insurance on the open market.
This seems a compromise that could serve all Americans. There would be a great many details to address, but it just does not seem that hard to set the parameters of a system that could both provide essential catastrophic care to all while retaining the benefits of market competition and innovation, simplifying the system, and lowering healthcare expenditures overall.
This is just one way to better serve the American people through compromise. President Trump has said, “We are going to take care of our people.” Here is an example of one way to accomplish that goal in healthcare that is better than both ObamaCare and any reform that might emerge from Congress over the coming weeks.