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Monday, February 27, 2017


Amazing how a smart guy that graduated from an important college in some sort economics degree doesn't understand the basics of the insurance industry. The larger the pool, the more stable and prosperous.
The single payer system does what conservatives and Trumpists want. It cuts out unproductive red tape and makes it a reliable way that providers like physicians, clinics, and hospitals get paid.
Mind you, I think at one time he may have endorsed a single payer system.

There are a lot of supporters of universal health care who don't understand that it's complicated, either. At least before the ACA was being debated, it wasn't uncommon to run across people who'd say that all we had to do was pass some law to adopt a single payer system and everything would just be okay--no worries about how to pay for it, about the difficult decisions of compensating doctors or denying coverage for certain items or wait periods.

When I asked one person who claimed to have worked with Hillary in 1993-1994 on that health care bill (and who should therefore know about how complicated health care is) about whether his preferred policies were constitutional and therefore likely to be upheld by the courts, his only answer was, "well, the government bailed out the banks, why can't it provide health care?" Good reasoning, but not particularly mindful of the fact that courts don't think like that.

Of course, if someone is president, that person should really know that health care provision is complicated, and even if he doesn't know it, he should go into it claiming to know it.

I can't remember who it was last week, but a reporter said that a couple of congressional Republicans told him that none of them had even attempted to understand how ACA works because it was an Obama/Democrat product, and they didn't need to understand it to oppose it. Opposition was a given.

So they might riff on little cherry-picked parts they'd heard (often incorrectly, I would add), without really caring about a deeper understanding of either the 3-legged stool or the cost controls. Now, as some of them are feeling compelled at look at ACA, they're realizing it isn't so simple a thing to shoot down or find a better replacement.

What troubles me further is that a large program like this needs to be tweaked as weaknesses emerge. It's unrealistic to expect that the first edition works perfectly. Medicare and Medicaid have repeatedly been adjusted to strengthen them. But if politicians are so opposed to programs without even knowing what they do or how they do it, they can do much to thwart the success of a program, without giving a rat's ass about whether or not the alternatives they leave us with are actually comparable or better.

Yesterday, Mitch McConnell had a tweet about what a disaster Obamacare has been, when, in fact, the Kentucky implementation is incredibly successful. Will it come back to bite him if the program is destroyed? That's what many Republicans are unsure about, but McConnell doesn't seem fearful. I think he's relying on two protections: 1) many people don't realize that the insurance they've purchased through exchanges and the subsidies they're receiving are Obamacare. They say they're against Obamacare, but they like the exchanges, the subsidies and Medicaid enrollment where applicable and 2) if things go south with repeal, he'll just continue to blame Obama for the fallout. Other Republicans have been showing signs that they aren't so sure that they'll get away with that. 20 million newly insured voters could present problems depending on the extent of any disruption. The fact remains that other than single payer, some form of the 3-legged stool is the only way to move toward wider coverage. I don't think there is a single health care economist out there who disagrees.

Yeah, there's lots to decry there and in the "we must always oppose" approach. I really do hope that Obamacare survives, and I think that means some sort of 3-legged stool (or my preferred policy higher taxes across the board, progressively increased with increases in income...but that's probably not going to happen).

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