Following Donald J Trump’s 2016 election victory, Republicans seemed poised to finally repeal and replace the Affordable Care Act (ACA). When the time arrived for votes to be cast, however, the repeal effort fell short, as Republicans just couldn’t withstand the media campaign waged against them. Democrats and activists portrayed Republican proposals as mean-spirited and cruel. Social welfare agencies called for retaining parts of the law that benefitted their clients. The tactics worked on the public as well. Opinion polls suddenly reported considerable support for keeping the ACA intact, and proponents urged addressing deficiencies in the original legislation rather than outright repeal. The seven-year “long game” of the GOP effort to overturn President Obama’s signature domestic legislation was effectively stalled, and doubt set in. Did Republicans ever really intend to undo the ACA, or was it just an act? As regards the entire health care/health insurance debate since 2008, it appears there’s plenty of deceit to go around.
Deceit was used to sell the Affordable Care Act. Most of us are aware of former president Obama’s claim that the ACA would allow patients to keep their plan, and their doctor, if they were happy with them. He also boasted that the average family of four would save about $2400/yr in insurance premiums. When the law actually went into effect, however, it became clear those bold predictions didn’t even come close to being true. Beyond those claims, the authors of the bill made promises to insurers, drug makers, and even skeptical Democrats in order to gain support for the law’s passage. The reform that promised so much carried a high price in bribes and enticements.
Deceit was used to save the ACA at the Supreme Court. Fast forward to the Supreme Court case, King v Burwell, questioning the constitutionality of the ACA. The case revolved around whether the government could mandate that citizens buy health insurance, and penalize them if they did not. Chief Justice John Roberts wrote for the majority that the mandate to purchase health insurance was constitutional after he unilaterally rewrote the penalty provision as a tax. The Chief Justice had stepped out of his role as judge to become a legislator. Political expediency had triumphed over the Constitution’s Separation of Powers.
Republicans rode deceit to election victories in 2010, 2014, & 2016. With the election of Barack Obama as president in 2008, the future of the GOP looked bleak. The partisan vote that won passage of the ACA breathed new life into the Republican patient. Opposition to greater government control over one-sixth of the US economy energized the Republican bade. GOP leaders vowed to repeal the new law, and rode that promise to win back both houses of Congress, and the presidency, in subsequent elections. But, while certainly willing to pass repeal bills when President Obama was sure to veto them, being in a position to actually accomplish their oft-stated goal produced panic. Battered by criticism from supporters of the ACA within the Democrat Party and the media, seven years of Republican boasts to remove the ACA “root and branch” were revealed as little more than empty political rhetoric.
Democrats employed deceit to save the ACA. As reported earlier in this blog, Democrats predicted dire consequences if the ACA were repealed. Social welfare agencies, and the media, emphasized improvements in the number of uninsured gaining coverage under the ACA, while virtually ignoring the law’s disconnect between having coverage, and actually receiving care. No sooner had the smoke cleared from the failure of the repeal effort, however, and Democrats were themselves turning on the law they had just saved. Facing yet another round of significant premium increases in the upcoming 2017 Open Enrollment period, calls for major changes to the law flowed like water from the Democrat side of the aisle. There were proposals to move the nation to a Medicare-for-all, or even a Medicaid-for-all, system, despite the shaky financial underpinnings of both programs. The same Affordable Care Act that just weeks earlier had been stoutly defended by Democrats was now the target of those very same defenders. Today, the impasse continues.
From all appearances, the Affordable Care Act looks like the law nobody wants, while at the same time being the law no one knows how to fix. Perhaps that’s because government can’t suspend the laws of economics. Competition and consumer choice, two bedrocks of the Free Market, can’t be superseded by government fiat. We are constantly told by politicians and activists posing as economists, that the Free Market won’t work in health care. Those same, self-professed experts can never explain why the market that works for every other product, service, and sector of the economy, won’t work for health care. In fact, it already does. In areas not commonly reimbursed by insurance, such as lasik eyesight correction and cosmetic surgery, competition has driven constant improvements in quality while lowering costs.
A more troubling scenario is the possibility that our elected officials, and unelected members of the federal bureaucracy, believe average Americans just aren’t capable of taking care of themselves. Whether Republicans or Democrats, far too many believe a compassionate government needs to protect people from the risks inherent in living. The best of intentions doesn’t make outside control any less abhorrent. And when the controlling party has the power to make decisions impacting your very life and health, it’s downright scary.
Instead, a free people need to be in charge of their own health care dollars. Refundable tax credits would allow citizens to choose their own health insurance policy, and make insurers compete for every single customer. Individuals would even be able to contract directly with doctors, and bypass conventional health insurance altogether. For those now covered by plans through an employer, let the dollars follow the individual, so that changing jobs, or even a layoff, doesn’t mean an abrupt loss of coverage, or mandatory switch to a new plan and new providers. Companies could concentrate on running their business rather than managing their employees’ lives. Medicaid patients should be allowed to add to the amount the government now spends annually on their behalf in order to purchase a commercially available policy that gives them greater choice of doctors. Rather than being stuck in a program that produces no better health outcomes for recipients than those without insurance, enrollees could choose a better plan that truly serves their needs. Likewise, Medicare Advantage plans have become very popular with seniors as private companies aggressively compete for the business of beneficiaries. Why? Because the Advantage plans offer better coverage for the same cost as traditional Medicare. The nation’s veterans should be free to seek out the best care available instead of being limited to the scandal-plagued Veterans Administration health system. If ever there were evidence that government-run health care is designed to fail, the VA is it. Our veterans should not be the recipients of second-class care.
While doctors and hospitals would also have to compete for customers, they’d benefit from added flexibility. Doctors and medical practices could negotiate agreements for care directly with patients, free from the red tape and interference often common with third-party payers. If a doctor, medical group, or hospital can deliver better care through innovation, expertise, or just plain hard work, let them share in a portion of the savings they provide to programs like Medicare or Medicaid. Government regulations shouldn’t favor the staus quo over a better mousetrap. There also needs to be a sharp reduction in the administrative burden placed on physicians. If a doctor wishes to be an administrator, that’s fine, but those involved in patient care should not be wasting time navigating a clumsy, user-unfriendly, data-mining software program. Big Data may have its place, but not as a distraction in the exam room. In putting the doctor-patient relationship first, doctors would find a powerful ally in those newly empowered patients.
This piece has covered a lot of ground. It’s reviewed the dishonesty and subterfuge that has underlined the health care debate in recent years. It has also proposed a solution that puts individuals in charge of their own health care, and makes insurers, doctors, and hospitals compete for customers on the basis of quality and cost. It’s even discussed the benefits such a proposal’s adoption could provide to the medical profession. Perhaps most importantly, it ensures each person retains the ability to run their own life, without the intrusion of a controlling government. Isn’t that the very essence of being a citizen?
Raymond T Kyle
Kyle Policy Partners Copyright 2017