Worry about Health Care Reform


I think President Obama won a great victory with health care reform.  Clinton attempted almost 20 years earlier and ended up with nothing.   Other earlier Presidents have been equally unsuccessful.  Seemingly the US hodgepodge of health system was due for an upgrade.  This might have rationalized our system that is a mix of a government run system (the VA), single-payer (medicare), private insurance for many and nothing but the emergency room for the rest.

It was a flawed victory though.  The reform passed was perhaps ambitious beyond our means.  While it reduced the deficit by imposing more taxes than the OMB judged it would create in new expenses, in so doing it has used revenue capacity to address the deficit.

The Republicans unwillingness to contribute to reform, or the President’s inability to induce them to, now puts the whole structure at risk of repeal.

I hope that the repeal and replace actually results in improvements but retains reform.  But I wonder if we could end up with nothing.

WordPress Tags: Worry,Health,Care,Reform,Republicans,President,results,improvements

This concern is shared by the incidental Economist here.

What I worry most about is the same thing that most concerns Harold Pollack:

[O]ne thing is certain. The new [health reform] law will need repairs and fixes along the way. There will be glitches. Specific legislative and regulatory provisions will require adjustment once they are tested. […]

[But,] there is just too little political space to implement midcourse corrections or enact programmatic improvements. That’s a price Democrats paid by achieving their dream of near-universal coverage on a party-line vote. That was a price Republicans paid, too, through their implacable opposition to just about everything Democrats proposed, including many ideas Republicans traditionally supported.

Each side had plausible strategic and ideological reasons to pay that price. For now, anyway, our politics give us the choice between health reform that is less flexible and less carefully crafted than it really needs to be, and no reform at all. If this is the political choice presented to us, I strongly prefer the first option. I still wish we had a better way.

Health (and other types of) reform are technically hard. But, more and more, I see political obstacles as the real barriers.

Pollack’s piece, a KHN column, is worth a full read. The vast majority of it is about the CLASS provisions. I think he summarized the issues fairly. It’s about as good a brief overview as you’re likely to find.

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4 responses to “Worry about Health Care Reform

  1. Bruce, I’m curious to know what you think about these poiints:
    1. if ‘Obamacare’ passes the Courts, a public plan might become much easier to do Medicare for All, which I beleive would lead to
    2. better cost containment and better health care

    Also curious to know if you think , re SS, the problems we face now will become moot once the bulge of the baby boom passes through the system. Won’t we return to a more balanced workers/retiree ratio?

    • I’ve never been enthusiatic about a public option. It seems to me if it’s cheaper, it’s because it’s inferior or subsidized in a hidden way. That is I’m dubious that the government can do a better job of running an insurance company than the private sector, with real competition. Make no mistake, that competion is somewhat limited now.

      Aren’t you suggested as some of the Obamacare critics that it was just a camel’s nose under the tent to get us to a public option, or even a single payer system.

      On SS being balanced once the baby boom is gone, I think you’re likely correct, but boomer are going to be around for another 30-40 years I’d say. I plan to live forever personally.

      • In fact Bruce, as to being cheaper, the rest of the developed world delivers cheaper health care and they have much better outcomes – much better, in addition to having access for everyone and no one left out.

        I am indeed suggesting it’s a camels nose – court approval of an individual mandate would make it much harder to demonize a public program.

        As for SS – me too! See you here in 2050! (actually, my partents and grandparents almost made it to 100, so . . . ) Glad you agree that the end of the boom will change things – given taht SS by most reports can easily pay out for 17 more years, a few adjustments to carry us the other ten or twenty should be possible and then we’re back on track.

  2. One final point on SS. More immigration will reduce the average age and make a broader working age population to support SS. They also would provide a market for our overbuilt housing stock.

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