Here’s the test for any Republican plan to replace the Affordable Care Act: Does it do what President Trump promised in January, only days before he was inaugurated? Specifically:
“We’re going to have insurance for everybody,” Trump said then. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” He pledged that those covered by the replacement for the ACA “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”
Two weeks ago, House Republicans rolled out the American Health Care Act, and it reneged on those promises. Costs would go up for the poor, while wealthier people would get a tax break.
Coverage would be limited. The requirement to treat addiction would be dropped, for example – and just when the nation is confronting a frightening opioid addiction crisis.
The problem is that Congress is starting from the wrong place. Its twin goals should be to ensure that as many Americans as possible have health insurance while doing as much as possible to lower the costs of care, or at least to slow the rate of growth.
To be sure, Obamacare needs repair. But Congress should be trying to make it work better, building on the elements that Democrats and Republicans want to keep.
Among the goals should be to reduce health care’s share of the national economy, which is fast approaching an unsustainable 20 percent. How can you bring it down? There are conservative moves Congress could make.
For example, it could move to lower the scandalous cost of prescriptions, in part by treating health insurance like a business: Allow Medicare and Medicaid to use the government’s purchasing power to secure bulk-rate reductions in costs that are frequently avaricious.
Congress could move to continue squeezing the practice of “defensive medicine” out of the system. That’s what happens when doctors feel pressured to order unnecessary tests as a protection against a possible lawsuit. Among the strategies should be lawsuit reform.
Specifically, Congress should look to impose reasonable restrictions on noneconomic damages in malpractice cases. It should acknowledge that while generous awards for pain and suffering have their place, some predictability is also important, along with fairness and sustainability.
Lawsuit reform has long been on the Republican wish list and, while Democrats would protest, they would surely swallow it as a condition of retaining the bones of the ACA. It’s not an unreasonable approach – at least, not for anyone who still believes that compromise is fundamental to governing a large and diverse country.
In unveiling the AHCA, Ryan complained that, under Obamacare, healthy people were paying to provide access and treatment to sick people. That’s not much of a scandal – it’s the insurance industry business model. A driver or homeowner may never make a claim after paying premiums for decades, but those premiums cover benefits for those unfortunates who do have to make a claim.
The first House bill fell quickly into the legislative dustheap. Hospitals and medical professionals said the plan was a failure. The Congressional Budget Office said it could reduce the budget deficit $340 billion over 10 years, but at a cost of denying coverage to 24 million Americans. It would also cut taxes in a way that mainly benefits the wealthy.
In response, Speaker Paul Ryan agreed to changes in the bill meant to appeal to House conservatives. That may multiply its problems in the Senate, since even some Republicans in the Senate object to the burden it would impose on the poor. If it fails, Trump has suggested simply letting Obamacare collapse of its own weight.
But that, too, would be blamed on Republicans, since they control the levers of government. They need to do better and, given the stakes, Democrats need to be prepared to work with them.