Why is failure to vote for a replacement of Obamacare a disaster?

by w3woody

I’ve seen plenty of articles suggesting the failure to overturn Obamacare a disaster. Quite a few commentators have suggested this makes Obamacare a permanent law of the land, in the same vein of Row v Wade–forgetting the latter is presumed to have found a constitutional right, the former simply being a law. And like all laws, they are routinely rewritten.

(Remember: what the law giveth, the law taketh away.)

But I don’t understand why this is a disaster.

First, the principle objection I have with Obamacare is that it was so complicated it was absolutely chock full of unintended consequences. For example, it’s clear (as Obamacare slowly rolls out–remember: some aspects have still yet to be fully implemented, thanks to delays passed by executive order by President Obama) that this was not the “fuck-you” to the health care insurance companies promised by some Democrats. It’s also clear that the law’s attempt to rearrange the Health Care industry into a handful of large players (such as requiring doctors to bill through Accountable Care Organizations–which wiped out small practices across the United States) has been an unmitigated disaster in rural America, especially in areas previously served by small practices which were effectively outlawed by the PPACA. We’re watching skyrocketing prices as the price structures created by Obamacare fail to play out, and for ever person we can claim now has health care insurance (regardless of their ability to obtain medical care under existing Medicaid provisions) we see a small handful of people who suddenly find health care insurance expenses wipe out their family budget. And because we’ve forgotten Insurance is not Care–that Health Care Insurance does not provide Health Care–we have a lot of people running around with the equivalent of amusement park “fun bucks”, unable to spend them as no physicians in their area are accepting new patients on their insurance plan.

To me, this implies that Obamacare cannot be overturned wholesale. It implies that Obamacare needs to be dismantled, carefully, over the next few years, by laws of more limited scope.

To use a metaphor, we’re on a river headed towards the rocky shore. What we need is a course correction, not for the river to be nuked.

Second, as the Democrats own Obamacare, lock, stock and barrel, there really never was any political need for Republicans to “fix” Obamacare. Sure, plenty of Republicans were voted into office on the promise of fixing health care by constituents who find themselves increasingly unable to afford health care insurance, and unable to afford to use the health care insurance they have. (Remember: a Bronze Obamacare Plan requires 40% of all medical expenses up to $25,800 out of pocket expenses (for out of network care)–and in a country where the median household income is $55,775, this means medical bankruptcy for those who cannot afford a better insurance plan. And that’s on top of paying at least $10,000 per year for that bronze plan–though most people never see this, as the bulk of the plan is paid for by employers, putting downward pressure on salaries. And, of course, assuming they can spend their health care fun bucks–that there is a doctor where they live who will accept new patients on their plan.)

But the problems now taking place in the health care market were not created by those Republicans.

So ironically while many Republicans may find themselves in trouble for failing to act quickly to “fix” Obamacare (assuming a quick fix would not create a bigger train wreck), what alternatives do voters have? Voting for the Democrats who insist that everything is fine, that the emperor’s cloths are rich, lustrous and beautiful?

So I would suggest that this drive to overturn Obamacare is politically problematic, and is legally problematic. Better instead to introduce slow, limited fixes, and consider big changes later as they are better understood. Better instead to allow changes to percolate up from the various think tanks, and implement these well considered fixes than yank stuff partially baked off the shelf and ram it down our throats, as Democrats did with the original Patient Protection and Affordable Care Act, which was a partially baked plan when Obama latched onto it as a signature law.

(After all, remember the PPACA was so half-baked it created a loophole which left Congress without health care insurance for its members. A loophole which Congress quickly fixed.)

It’s clear with the failure this week of the hastily assembled Republican health care plan that Republicans decided not to rush into creating another mess.

How this is a problem or a failure for Republicans escapes me.