Speaker of the House Paul Ryan gave Thursday, you’ll see that he understands the problems. His argument is, basically: Democrats screwed up the health-care system. They won’t let us fix it cleanly, so if we’re going to do something, these half-measures are the best we can do. Let’s get this passed, address what we can through regulatory changes, then force Democrats to come to the table to negotiate the rest.
- .. One, the exchanges where individuals buy policies could fail, leaving people unable to buy insurance.
- Or two, the exchanges don’t fail, and we’re left with an unsatisfactory but still operational system.
.. In either case, the Republicans’ best option is to wait. Why? Because what they can do now — hastily, without touching the underlying regulations that have destabilized the individual market — is worse than either of those outcomes.
.. Stop the funding games the Democrats were using to prop up the exchanges. And if the exchanges collapse, say to the public: “Hey, look, we didn’t touch the individual market.
.. The only possible way to shore up Obamacare’s flawed design is through a big increase in subsidies for individual plans and bigger tax penalties for those who don’t participate. Democrats didn’t have the guts to do this, and they liked Obamacare.
.. Whatever it is, they’d better be prepared to do it fast, because if the individual market does collapse, there’s going to be a political crisis. They need to think about this now and have a bill ready to go as soon as it happens.
.. have the government pick up 100 percent of the tab for medical expenses that exceed 15 or 20 percent of a family’s adjusted gross income: basically, a single-payer catastrophic-care system for expenses that no one can realistically save for. Let people buy insurance for expenses below that, or, if it’s not too expensive taxwise, let people set aside more money tax-free in Health Savings Accounts. And make some more generous provisions for people closer to the poverty line, such as prefunding Health Savings Accounts for them.
.. voters don’t want genuine insurance, by which I mean a pool that provides financial assistance for genuinely unforeseeable and unmanageable expenses. Voters want comprehensive coverage that kicks in at close to the first dollar of spending, no restrictions on treatments or their ability to see a doctor
.. nor do they want their taxes to go up, or to pay 10 percent of their annual income in premiums.
- Old people hate paying more, of course. But the effect of the current system is to drive young people out of the market — which means that premiums are set to cover an old population, which means high. It’s not clear that this actually benefits old people in the long run.
.. There are too many Republican governors and senators among the 32 states that expanded Medicaid for total repeal to be politically feasible
.. The current financing structure, in which the federal government matches whatever states spend, encourages states to use the program as a piggy bank to reward favored interest groups in the health-care sector, without necessarily providing very good care to the poor. As Brian Blase of the Mercatus Center recently put it, “Because Medicaid spreads the burden of state spending decisions in this way, many states grow inefficiently large programs and create numerous accounting gimmicks to access as much federal money as possible.
.. A plan based on these ideas may, to be sure, end up covering fewer people than Obamacare currently does. But then Obamacare may end up covering fewer people than Obamacare currently does, because it seems to be slowly strangling the individual market
.. What they can’t afford to do is try to get it done in stages, or do half of it because that’s what can pass. That kind of thinking is what got us into this mess in the first place.