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Life Support

The Affordable Care Act, ACA or Obamacare, has proven difficult to kill off. In the next eight days we will see if the last, final, we-really-mean-it effort suffers the same fate as the previous attempts.

It should die for even more reasons than the last attempt. But that doesn’t mean there isn’t actually be something of value in Graham-Cassidy which might lead us to even better healthcare in the future. If that fails, it could well lead us to a final calamity for the Republican Party.

Sen Bill Cassidy (R-LA). He’s got a term paper due, but midnight is a good time to start, yes?

There’s a lot to dislike about Graham-Cassidy, as far as we can understand what it is. While it pledges to protect those with pre-existing conditions, it does allow insurance companies to charge higher premiums based on health history. That would have the effect of pricing out people who have anything in their past and put us right back where we were before the ACA.

Of course, we don’t exactly know how many people would be affected because there hasn’t been enough time to do an analysis. The Congressional Budget Office (CBO) won’t have a final report done in time for a vote scheduled before 30 September. That’s a hard deadline.

Why is this the deadline? Because after that, a rules agreement opens the debate to filibuster, meaning that the Democrats can force a cloture vote requiring 60 Senators, not 50. If the Republicans are to act on their own bill, without bipartisan support, it has to be now.

The rush job and lack of specifics are reason enough to put a stop to this.

It gets more colorful if you do it this way, too.

There is one new angle in Graham-Cassidy, however. It effectively pushes everything away from Washington to the states to administer with block grants. Democrats have been very suspicious of this approach for obvious reasons, but they shouldn’t be. This could be the breakthrough we’ve been looking for.

A similar system was part of the foundation of Obamacare in the first place. States were expected to set up exchanges for insurance and generally administer them. The federal system was intended only for those states which opted out of running their own. In total, 26 of them did, mostly out of spite. If the system had run as it was supposed to it would have been entirely state run from the start.

In political terms, putting states in charge of health care is very likely to damage the Republican Party dramatically. Statewide elections in 2020, a redistricting year, could well hinge on the quality of healthcare provided by the state. It’s hard to find a better gift to the Democratic Party than that. But this kind of analysis isn’t all that helpful for designing a good system.

Federalism feels like this sometimes.

What would a good system look like? States do a good job of running most things, and are indeed a good place to look to develop a functioning system. Some already do a good job, and their advanced system development would be rewarded if they had more control. It requires uniformity, however, especially in areas which promote portability and in billing – one of the failures of Obamacare in the first place.

While this may be a good idea all around, it needs time to be worked out properly.

The pitch for any Democratic Senator twisting the arms of their Republican colleagues right now has to be a pledge to work towards making this work. Let the clock run out on this month and we’ll be there with you, the pitch would go. Pass this turkey and you know we’ll crucify you for it. The choice is yours.

Old fashioned hardball in such a critical area is rather repugnant all around, certainly. Yet that’s where we are with this.

Is it a market or not? Pick one. Please.

The best reason to vote against Graham-Cassidy? We really don’t know what it might do. But if you can recast that as an opening for the bipartisan effort to craft a solid healthcare plan, as we should have been doing all along, we have a positive. There is some actual movement in healthcare legislation after all, and it may be going in a positive direction.

Throw in an option to buy into Medicare and we’d have a system very much like Germany has. It’s not necessarily bad, although uniform reporting and billing would have to be a part of it. At least we’d have another nation to start looking to for guidance.

Obamacare was never a bad idea. It was a half-baked idea limited by what could be crammed through at the time to avoid a coming crisis in insurance affordability and availability. It’s worked well for what it was. New legislation should be about making it better, and that’s going to be bipartisan. Letting the clock run out is the first step towards being serious about that.

3 thoughts on “Life Support

  1. Why isn’t it obvious that healthcare has to be a bipartisan issue? Like you said before there is a place for pay as you go and HSAs for small things but we are totally not set up for it. This new Cassidy plan does remove insurance for people with pre existing conditions I don’t care what they say. That is just crazy. Why are they doing this? to make a political point? This is so bad.

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