The basic problem in American politics today is we are asked choose a side. Either we are supposed love Obamacare or hate it depending on our political affiliation. That we somehow must think Obamacare has been either a savior or villain is the fault of our self serving politicians. Both sides are equally to blame. Democrats seem to love government based solutions and Republicans like to think that if we could just get government out of the way all our problems would disappear. The older and hopefully wiser I get the less convinced I am that either side is right espousing ideological purity.
Here are the problems we face no matter what side you are on. Obamacare greatly expanded coverage but premiums and deductibles rose significantly particularly for those making a middle class salary. While most of us get coverage through employers that doesn’t mean we are unaffected by Obamacare. Employers have held premium increases somewhat in check but have done that by increasing deductibles.
Obamacare did not achieve the promise of lowering premiums for the average family. That certainly did not happen for most of us covered by employers. On the other hand it did allow many lower income people to get basic coverage through Medicaid and the exchanges. That is a good outcome for them, but we all subsidize that through higher taxes and increasing costs for our healthcare.
Like it or not we are now a country that has shifted much more of the healthcare cost burden to the consumer. This is mostly through those higher deductibles. They rose 12% in 2016 for the average employer based plan to $1478. That is cheap compared to people buying plans on healthcare exchanges where the family deductible will be over $12,000 in 2017 for the Bronze plan. With that kind of deductible most families are just getting a plan which they can use when serious illness hits.
So why are deductibles so high? First we added a lot of people with pre-existing conditions. Second we capped the cost of coverage to older folks while charging young people more than their fair share. Not enough young people are signing up so we are seeing insurers raising deductibles to lower their exposure.
Republicans and Democrats must get around the war of ideology and actually work the problem. A dose of competition across state lines is an option to consider to increase the number of insurers in the market. So is a reduction in mandated benefits to lower the cost to the younger age population. There are better ways to provide health services at lower cost such as reducing regulation to allow more physician assistants and nurses to do what physicians do.
There is no shortage of good ideas. The barrier is we have this ridiculous idea that you must love Obamacare or think it is the end of civilization. Republicans shout for all out repeal and Democrats blindly call for expansion to single payer. How about we meet in the middle? There is no shame in admitting Obamacare has some good points and bad points. There is also nothing wrong in thinking HHS boss Dr. Tom Price has some solid ideas to lower costs. Instead Nancy Pelosi and Chuck Schumer have continually vilified him as someone who wants to take away your coverage.
President Trump has shown little desire or aptitude for getting into the policy weeds here. He ran on Obamacare being a disaster but beyond a few talking points I doubt he understands the realities of reform. It will take political courage to compromise and blend free market reforms with Obamacare. Right now the war in Washington will prevent that. Dems want to pander to the progressive wing and Republicans are unsure how far right to go trying to appease the Freedom caucus.
Unless we fix the underlying issues deductibles will keep rising and all of us will be essentially self insured except for a catastrophe. That is not all bad since spending our own money will make us more cautious consumers. We will demand less testing and negotiate harder with providers. More services will be developed to help us evaluate price/quality of physicians and hospitals. That will make providers focus on value based marketing.
It is not surprising why Congress’ approval rating is so low. And healthcare is a perfect example of the failure to help the American people because of pig headed ideological positions not based on facts. They deserve the criticism and they are on a path to zero approval. Sad indeed but here we are unless moderates re-emerge on both sides to actually solve problems. That is something that will take guts, and guts are in short supply right now on Capitol Hill.