The GOP health care bill, scoring and the bat-shit media.
Democrats immediately blasted the bill based off the report’s findings.
“I think that throwing 24 million Americans off of health insurance, raising premiums for older low income Americans, while giving $285 billion in tax breaks to the top 2% is a disgusting and immoral proposal,” Sen. Bernie Sanders of Vermont, told reporters. “Thousands of Americans will die if this legislation is passed and we have to do everything that we can to see that is defeated.”
I have a few thoughts on this.
First, let me renew at this time my objections to every form of health care reform that addresses just the demand side (through insurance reform) and neglects the supply side. (This won’t work, and it’s self-evident why., Supply And Demand.)
This objection applies to both Republican and Democratic proposals.
Second, let me note that the CBO estimate does not suggest that the new bill will “[throw] 24 million Americans off health insurance.”
What happens is that, by repealing the penalty for not obtaining health care insurance, the CBO believes fewer people will sign up for health care insurance. (They never expressly state this, but they note the current demand created by Obamacare is triggered by subsidies plus current penalties.)
The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.
The CBO also notes in its report its belief that by removing the penalty for failing to have health care insurance, the complete failure of the individual market in many states will accelerate–though the key word here is “accelerate”: the CBO soft-peddles what happens under current law, but it does note “[s]everal factors could lead insurers to withdraw from the market” in various states under the current Obamacare legal regime.
The private health care market is currently collapsing, and the current GOP bill accelerates this collapse–assuming no further action is taken in the health care market.
This is by design: there were several who promoted the passage of the PPACA in order to force insurance companies into a corner, causing the introduction of a “public option” which would lead to “single payer.” ObamaCare a Trojan Horse for Single-Payer.
And complaints that this will increase the cost of private insurance–well, hell: that ship has sailed. In North Carolina an individual plan on the private market has gone up 20% just in the past year.
“But my health care insurance plan hasn’t gone up in price.”
If you have your insurance through your employer, various executive orders signed by the Obama Administration delayed the roll-out of PPACA requirements on employer-provided insurance. This is why the group health care insurance market is not in as much trouble as the private market: the private market is required to provide much greater coverage over a broader range of essential health benefits, while employer-provided insurance does not. Insurance plans purchased through the Health Insurance marketplace is also required to fit one of a handful of templates: bronze, silver, gold or platinum, which establishes nearly identical deductions and co-pays. (The differences in plans offered on the marketplace revolve around out-of-network costs, and the size of the network.)
And group insurance can be bought for any company employing two or more individuals–with substantial savings: a bronze plan in North Carolina averages around $600/month per person for the cheapest option, while a group insurance plan can be purchased for $350/month per person total (half paid by employer, half by employee).
(Truth be told, if my wife and I found ourselves in the private market, I’d consider figuring out how to obtain health care insurance for the both of us through incorporating a small corporation.) This is no longer a permitted option for small companies.
Had the PPACA requirements on group health care insurance plans were permitted to be implemented, we may see private insurance costs go down some, but we’d also see employer-provided health care plans rise in price–and with it a rise of companies reducing hours to below the 30 hour limit that triggers the PPACA requirement for employer-provided health care coverage.
President Obama knew this, which is why large chunks of the PPACA remain unimplemented.
This is currently unsustainable.
The PPACA and its changes to the marketplace were substantial and complex.
Thinking we can resolve the health care crisis with a single “big-bang” bill thrown together in a few months and implemented within the first year of a new President getting into office: well, hell; that’s how we got here in the first place.
Which is why my third thought on this: I don’t mind if President Trump and Congress take their time to come up with a better plan. I actually would prefer if we got a series of bills which seek to unwind those elements of Obamacare which is leading us towards disaster.
But part of that must address the supply of health care in this country. This means considering reforming everything from how we approve non-drug related diagnostic equipment and how we approve new hospitals being built, to considering malpractice reform and reconsidering the scope of practice of various medical professionals in the marketplace.
In other words, we need to allow new players to enter the health care market in order to innovate and come up with new business practices, new procedures, new software solutions, and new equipment in order to improve the supply of health care provided in this country.
Otherwise, any plan the GOP comes up with, just as any plan a future DNC controlled Congress comes up with, is just rearranging the deck chairs on the Titanic.