I don’t make any secret that I think this election’s outcome rode on two things that really had little to do with the candidates running for office. First and foremost, the voters are sick of being treated like idiots and being told they should sit down and shut up and let the elites run the country. But also, Obamacare became so painful that people were willing to vote for anyone who promised to make it go away. It literally blew up in the weeks before the vote and proved once and for all that the “Affordable Care Act” was anything but affordable.
Let’s be honest. Medical care is a necessity. Sooner or later we all have to go to the doctor for something. Even before Obamacare, health care coverage was hard to come by and too expensive. Prescription drug prices were out of control. There’s so much wrong with the American healthcare system that Obamacare was just the nail in the coffin. Our medical care is among the best in the world, but the system of delivery is hobbled by government mandates, subsidies, price controls and myriad middlemen standing between the customer and the provider that our access to medical care is expensive and often impossible. It is seriously over-regulated and filled with government-created monopolies.
Instead of introducing more competition and market forces into a monopolized system, Obamacare took that hobbled system, fed it a steady dosage of steroids by creating more mandates, price controls and subsidies and this blew up the average middle-class family’s budget.
People are now waking up to the many bad features of Obamacare. Some of us recognized these problems before the act was passed, but now we’re all experiencing the pain. The ACA combined a mandate that insurers not discriminate against preexisting conditions with weighted pricing, which meant that healthy people were forced to pay the astronomical medical costs of very sick people. This, ultimately, is what caused the death spiral. Here in a Alaska, an insurance pool of 8,000 people was faced with millions of dollars in claims from just a dozen subscribers. That necessitated premiums in the thousands every month, which simply could not be sustains, so the insurer left the marketplace, leaving only one insurance provider for the entire state. Zero competition means the insurer can set whatever price they want and …. yeah, death spiral.
Additionally, the ACA put too many restraints on competition across geographic lines. There were, at the time of the ACA’s passage, hundreds of insurance companies and some of them provided insurance at affordable prices, but since I live in Alaska and those companies were located in Connecticut, I couldn’t buy my insurance across state lines. I was forced to pay a much higher premium here in Alaska. Meanwhile, I buy my car insurance across state lines and get good Alaska-compliant insurance at an affordable price.
Probably the worst feature of the ACA is hardly mentioned. It prepackaged precisely what must be insured, and allowed no room for flexibility. So healthy people like my family couldn’t opt out of insurance coverage we don’t need. This is one reason premiums rose so much so fast. Insurers simply tallied up the benefits and the risks and dished out new terms. There was no negotiation possible.
Fixing Obamacare is probably not possible, so it probably needs to go away in order to be replaced with …
Well, there’s a question. All this bad regulation that existed pre-ACA dates back decades or even a full century. It’s this incredible bundle of red tape encompassing how doctors get their training, where doctors may practice, how medical facilities are licensed, how medications are approved, what doctors may prescribe what medications to whom, etc., etc., etc. I don’t think DC has the political courage to address all of it, although the REINS Act might take a machete to some of it.
Or we could just take the easy route: let insurances offer to willing buyers whatever kinds of medical care coverage they want. That’s how we conduct our lives in almost every other area. If you go to McDonald’s and ask for fries, they don’t say, “Sorry, we can’t sell those separately. You have to buy the double Quarter Pounder Value Meal with a dessert, or else we can’t sell you anything.”
Get rid of the government mandates over what can and cannot be part of what is called health insurance and let consumers and insurers negotiate one-on-one to decide this for themselves. This would immediately create a variety of new lower-priced options because people who demand it and insurance companies that wanted to stay in business would seek to be competitive by offering more and more affordable options.
Donald Trump will be President in part because he recognized that Obamacare needed “repeal and replace” while Hillary Clinton proudly patted herself on the back for it being her brainchild in the first place. You just can’t undo stupid, I guess.
At the very least, if President Trump wants to keep the campaign promise he’s backpeddling on right now, here’s how he might do it. On the first day in the Oval Office, sign an executive order opening health insurance up across state lines, allowing anyone to buy state-compliant insurance from anywhere else in the country and then ask Congress to address the morass of regulations that is hindering the medical care delivery system in this country. Do what everyone applauded Lyndon Johnson for doing with Civil Rights. Ask for a bill to be on your desk by the end of 2017 and watch what good things might flow from that.