Can we "fix" Obamacare or make it better?

quote:

---

etc.. You can also take out the mandates.

---

quote:

---

No mandates means it will collapse

---

It's collapsing already

The republicans should've started working with Obama to fix it 4 years ago. But they put politics before country like they always do.

Health care is a right, not a privilege relegated to a wealthy few.

Why do you guys never give specifics as to what "fixes" there should be?

In short, no. Having a few hundred bureaucrats try to creat a unique set of laws to govern millions of healthcare transactions is doomed from the start. Hence why we've been at it for decades.

Some day it will be drilled in the right people's head but I'm not optimistic. People of that stature are always prone to be enamored with their own intellect.

quote:

---

Why do you guys never give specifics as to what "fixes" there should be?

---

I will preface by saying, this is not an endorsement of this as my preferred ideal of reform, just answering the question in a realistic way considering political realities. For instance I am constraining myself to things that can pass through reconciliation and minimize political blowback that has continually derailed larger reforms for over a 100 years(meaning I am not mentioning strong arming pharm companies that will pour billions into scare tactics, eliminating the employer sponsored insurance subsidy that will enrage most businesses, price controls that will piss off care providers, reforming insurance to make them operate more like in other countries which will piss off money hungry insurers, or other broad reforms that need 60 votes and are unlikely to have enough support to pass).

1.) Allow people 50 and up to buy into Medicare.

One of the problems with the employer market currently is it distorts things like retirement and creates job lock. Employees that otherwise have enough money to retire stay working longer because they do not yet qualify for Medicare. This drives up unemployment in younger generations as more people are staying in the workforce longer, reducing employment openings. Allowing these people to buy in would also had the added benefit of helping offset the costs of more expensive enrollees subsidized by taxes and reducing risk in the private market. Since it deals with spending it would likely be passable under reconciliation.

2.)Raise the subsidy threshold for Medicaid and individual market users and scale the rise more effectively.

Deal with the subsidy gap in the individual market where people no longer qualify for subsidies but insurance is still too expensive. Which keeps healthy people out of the pool and thus harms the level of downward pressure that can be put on premiums. Scaling the subsidies more effectively would help deal with the problem of people potentially worrying about losing Medicaid for a marginal change in income since the difference between what you get with Medicaid is often much more beneficial then what you can get with a individual plan, even one highly subsidized. This is ultimately a very complex discussion to get into so I won't go much further here.

3.) Re-institute the reinsurance and risk corridor provisions temporarily to re-establish the marketplaces.

These are provisions that got highly beaten down by Republicans for various political reasons and harmed the market early on, especially in terms of the co-ops that were forming up in many places, and ironically were things they put back into their AHCA bill indirectly that didn't get a lot of press, because they recognized they work in helping get insurers into risky markets and allow enough time to stabilize and to keep premiums from jumping up too much in the early years of major changes as a way to prevent market collapse in volatile early years.

4.) Add a public option

Especially in rural areas, it is just generally hard to foster the sort of competition people on either side say they want to happen in these areas. In large part because the hospitals tend to have all the leverage. If you re the only game in town, you have all the leverage in negotiations and can price yourself fairly high. A public option provides a mechanism to provide an alternative that keeps pressure on insurers that can often be left in a monopolistic position and helps pressure prices in negotiation with care providers.

5.) Increase the mandate penalties.

Though unpopular the mandate servers a pivotal purpose of getting healthy people into the pools to help spread risk, drive down uncompensated care and spread costs. The mandate penalties would come in conjunction with the above shifts and rises in subsidies to make sure people are not getting forced into buying a product they can't afford or paying a penalty they can't afford.

Of course ideally I would want some major policies to reduce costs and prices in healthcare but that is a very politically difficult place to get to, though necessary. I would also want some investment into shifting the tort structure to a more equitable and cheaper system, investment in technology to better coordinate care, improve medical record portability and provider communication that will help drive down costly errors.

quote:

---

Health care is a right,

---

Nope.

quote:

---

number 5 on your list would be a bad deal politically speaking.

---

Like I said, you would have to do it concurrently with improving subsidies to reduce the cost liability.

But to the larger point, there are no free lunches. Every decision has winners and losers and especially in healthcare, this is an even more difficult mine field to maneuver.