Friday, January 13, 2017

Health Care Now

Krugman writes, yet again, on the politics of health care reform. In 2008 and 2009, given where we stood as a society, and what can actually work as a practical matter, the combination of the possible outcomes looked something like this:
-Do nothing. Medicare covers Americans age 65 and older. Employers cover most full time employees. Small employers cobble together expensive coverage options for their employees. Millions fall through the cracks without medical insurance.

-Establish single payer healthcare system similar to all large advanced nations that had similar values to the U.S. at the time of the Obama administration. As Krugman points out, this was a nonstarter due to political opposition.

-Comprehensive reform with the goal of providing Affordable Health Care Coverage for all Americans. (Was that such a terrible goal.) Effectively only a system similar to the ACA could work which is why Massachusetts established such a system when Romney was governor.

-Modest reform to make improvements, but avoid addressing the key concerns. A last minute push was made to lower the age for Medicare coverage to age 55. That falls short for many over 55s without the subsidy and leaves out many others.

My comment on the Krugman piece:

Yesterday, Ryan repeatedly referred to the GOP's "rescue mission" to "repeal and replace". Like Trump, the GOP is so much better at the art of the catchphrase in service to lies and distortions than Democratic legislators are in efforts to bring reality to life with true statements. If the House GOP is so interested in a rescue, where were they when tweaks to the law were needed over the past six years? Fighting against the expansion of Medicaid. Fighting the law in multiple court cases. The GOP has no interest in health care reform as anyone would define it. Yesterday Sen. Cotton talked about reform that would allow someone like him to buy a "skinnied down" plan when they are young and not planning to start a family, then buying a more generous plan that covers maternity benefits when they plan a family. That's not how insurance works. That's how insurance fails - by antiselection. But the GOP will continue to focus on controlling optics and ignoring reality. You can bet we will have a health care cliff, similar to the fiscal cliffs of recent years, with the timing of the HC cliff geared not to the needs of people and insurance companies to adjust, but to the midterm and 2020 elections.

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