Sunday, December 8, 2013

It's Time to Make the Affordable Care Act Work



As I've said, it's not pointing out the weaknesses of the Affordable Care Act that bother me, it's the constant drumbeat of tragic negativity that drives me to distraction. And that drumbeat is led by the GOP. There is a real opportunity to address structural deficiencies in President Obama's plan to reform health care delivery and insurance.

For instance, at it's best, tens of millions will be left without health insurance. In states that have opted out of setting up their own health exchanges and refused to expand Medicaid, is there a solution to cover these Americans? Or, what about those citizens who may actually have to pay more for insurance in a state or federal exchange? What about a tax break for them on the difference between what the exchange offers and what they would have to pay should the decide to keep their insurance? What the Republican dominated House of Representatives doesn't understand is that 'repeal and replace' is not an option and 'we will all die' is not policy.

Washington Post columnist Kathleen Parker has it right when she says, "When Republicans say the health-care plan is doomed, a train wreck, a disaster, etc. — and offer no hopeful options — they appear to be rooting only for failure.


"This approach is a blessing for Democrats, who have responded by shining a light on success stories: the 25-year-old who gets to stay on his parents’ insurance plan another year, the child or elderly parent with a preexisting condition who now can get insurance, the family who never could afford insurance and now can, thanks to . . .well, all those people who are now mandated to buy insurance of a certain type or else.
"Comparing approaches, President Obama is wearing love beads and planting flowers in the gun barrels of the Republican guard.
"What Democrats know keenly — and Republicans seem never to learn — is that positive beats negative every time. Thus, we see MSNBC’s clever montage of Republican negativity: A series of unfriendly faces decrying the Affordable Care Act (ACA) with apocalyptic language. Which would any everyday American prefer? The healer or the doomsayer? The elves or the orcs?
"This is not precisely reality, but perception drives policy as much as reality does. The key for Republicans is to drop the negative attacks and refocus energies on the positives of their plans..."
Of, course that begs the question, "What plans...?"
Parker is left with remnants of plans that have been proposed and rejected. For instance, she cites remedies offered by for U.S. Senator Kay Bailey Hutchison (who by the way, was one of the last sane voices to leave the senate) and Frank Macchiarola, former Republican staff director of the Senate Health, Education, Labor and Pensions Committee. Their proposals include, "...improvements to our health care system should begin with a basic focus on three core principles: reducing the cost of health care, providing greater access to care and increasing the quality of the care provided.
"It is important to recognize that, for too long, too many health care consumers have been separated from the cost of care and thus have no incentive to make the wise choices they would otherwise make as informed consumers.
"Policies such as unlimited health savings accounts to address this problem would go a long way toward reducing healthcare spending by the consumer. Additionally, health care consumers value greater choice in shaping their own needs. Forcing people into exchanges that dictate the type of care they must receive restrains choice and increases costs."
Of course, all of these might be reasonable alternative proposals if all consumers of health care were savvy customers - or if the earned enough money to not have to make  a choice between say, an electric bill or rent, or a health savings account. Not to mention the fact that not only are the 'three core principles: reducing the cost of health care, providing greater access to care and increasing the quality of the care provided', at the heart of the ACA but people are not 'forced' into exchanges, they are given a range of options for coverage within those exchanges.
When the Affordable Care Act was introduced, it was criticized as being a too complex, system wide overhaul of a medical delivery system wrapped around the axle of our economy. It was, after all, 1000 pages long - who had time to read it (except lawmakers with staff whose job it was to do such things). And on occasion a Republican lawmaker would come up with an alternative: generally one sheet of paper, written on (front and back - I hope), that was the cure for 'Obamacare'. That plan was rejected. 
The Affordable Care Act was brought of for repeal of some sort, almost 50 times. The Supreme Court found it fundamentally Constitutional. It was litigated and voted upon in Congress and every lawmaker, had a chance to cast his or her vote for or against it. The President ran on it as a signature piece of legislation passed during his first term. Radical Republican Conservatives shut down the government over it's implementation. 
And yet it remains the law of the land. 
It's time to make this work. But that does take statesmen with standing who have the future of their country in mind, not just politicians determined to gin up their base for the next election. 

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