Mitt Romney, former Massachusetts Governor and GOP candidate, has decided to re-embrace his Romneycare. On yesterday’s Meet The Press, Mr. Romney again told us that he would repeal Obamacare on his first day in office. That’s not new. David Gregory then asked him about the people who have benefited from the Patient Protection and Affordable Care Act (PPACA) such as adult children in their 20’s and people with preexisting conditions.
I’m not getting rid of all of health care reform. Of course there are a number of things that I like in health care reform that I’m going to put in place. One is to make sure that those with pre-existing conditions can get coverage. Two is to assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they might like.
We haven’t learned a thing. The first edition of this blog discussed the difficulty of making tough, adult decisions. It has been three years, countless pages of legislation, rules and regulations, and a couple of election campaigns and we haven’t begun to move forward. It is one thing to use a spoonful of sugar to help the medicine go down. It is quite another to skip the medicine and eat all of the sugar.
Before Mr. Romney’s surrogates have a chance to take to the airwaves to tell us that he isn’t backsliding and that their candidate really, really hates Obamacare, all of it, let’s go over a few of the basics:
• We can ask questions and underwrite with the option of pricing based on the risk or we can insure everyone and come up with an average price.
• Healthier and younger people will pay more under an average price system.
• Many of the healthiest and youngest would pass on coverage until they needed it, if given the chance.
• The current healthcare legislation and debate has almost nothing to do with healthcare. We are simply discussing how we pay providers.
• Inaction is a whole lot easier than action. Specifics are down right dangerous.
Elected Republicans have little interest in repealing the Patient Protection and Affordable Care Act, not because they like it or agree with it, but because the alternative is worse. The alternative would be the responsibility to create a better program! The PPACA created a bridge plan that insures the previously long-term uninsured. It was (is) a costly program that is helping individuals with expensive, life-threatening preexisting conditions. Repeal the law first and then create the alternative? What happens to those people? If the law is repealed, or if the House Republicans simply carried out their threat to defund the PPACA, these people are no longer insured.
Less dramatic, the number of uninsured twenty-somethings has also declined in the last year. The PPACA is the only reasonable explanation. Dump the law and there is no guarantee that the insurers won’t dump the 25 year old still clinging to mom and dad’s policy.
If the Republicans had ever been serious about changing and improving the Democrat’s legislation, there would have been an honest effort to amend it. Instead the second bill to be pushed through by the House Republicans was H.B.2 Repealing the Job-Killing Health Care Law Act. So nothing got done. But doing nothing was the goal. It is far easier to campaign and raise funds in opposition to legislation than to create and defend your own solutions. If Mr. Romney wins the White House and the Republicans won the House and Senate, the most popular guy in Washington would be the Democrat responsible for the filibuster in the Senate that would save the Republicans from themselves.
So where are we? We still have a system that is based on demand, not care, and certainly not about outcomes. Our hospital buildings multiply like rabbits. Television and radio feature an almost endless barrage of ads for medications and treatments, many with the promise of little to no charge for the insured or aged. And we have become addicted to free stuff, whether it free exams, free pills, or free scooters for those who are no longer mobile. We want to tax others and limit access to care as long as we get to choose how and how long we live.
Where else but in the United States would you have attorneys advertise how to shift your assets to your children so that the government (Medicaid) will pay for your nursing home expenses?
So it may be time to bring healthcare into the healthcare debate. What care are WE willing to fund? What care are we willing to forego? Will the rich be able to get better care than everyone else? Of course. We don’t pay for cosmetic surgery now. In the future we might not pay for heart transplants for 70+ year olds. Or maybe we will have a national discussion and make that choice.
I just hope that we’re doing better before the 200th edition of this blog.