Obamacare in Limbo: Repeal or Let Die

At Hot Air, we read that on Jan. 4 President-elect Trump tweeted: “Republicans must be careful… that the Dems own the failed ObamaCare disaster.” On Jan. 11, Business Insider quoted Trump thus: “They own it right now. So the easiest thing would be to let it implode in 2017 and, believe me, we'd get pretty much whatever he wanted. But it would take a long time.” So back in January, Mr. Trump seemed to think that the right course was to be proactive and repeal.

But on Feb. 15, the Daily Wire ran a compelling article headlined “Why Trump Should NOT Repeal or Replace ObamaCare (Just Let It Die)” by John Nolte, who counsels otherwise:

Why should Trump and the GOP deal with the headaches? Why take the political hits? Why face two years of the Left rioting and the national media calling you a Nazi? To finish off the destruction of ObamaCare, all Trump and the GOP have to do is a whole lot of nothing….

In other words, let ObamaCare continue in its “death spiral,” which is what ObamaCare is now in, according to insurance giant Aetna. (Mr. Nolte also offers up some fine suggestions for fixing the nation’s healthcare, and with brio.) And in “Trump Administration Withdraws Some Obamacare Ads as Deadline Nears” at Bloomberg on Jan. 26, we read (italics added):

Robert Laszewski, a health-care consultant who’s critical of Obamacare, called the move to halt the advertising “short-sighted.”

“Doing this just gives Obamacare advocates ammunition to later say Obamacare failed not because it was deeply flawed but because the Republicans killed it,” he said. “If the Republicans believe Obamacare is failing, then just let it fail and let it be clear it failed because it was flawed, not because the Republicans sabotaged it.”

Good point, but the same concerns can also be raised about any executive order on ObamaCare, such as the president’s directive to the IRS to not enforce the individual mandate on this year’s income tax returns. The same thing might be argued if the GOP is not forthcoming with funds for the various bailouts that are embedded in ObamaCare, like the “risk corridors” bailouts.

When predicting ObamaCare’s imminent demise, one needs to remember that the system has two sides. There’s the welfare side, i.e. the expansion of Medicaid, and then there’s the private sector side. The first component of ObamaCare to fail would likely be the exchanges. That’s because they involve private health insurance companies that must make a profit. These companies are leaving the exchanges. But the Medicaid side of ObamaCare isn’t concerned with profits, nor does Medicaid have a dedicated tax and “trust fund” like Social Security and Medicare. The Medicaid part of ObamaCare will likely keep on limping along, getting regular infusions of money from the poor taxpayer.

So one can’t be so sure that all of ObamaCare will fall on its own; it may need a little shove. But repeal will reap the political grief for the GOP that Nolte writes about and that we’re seeing at town hall meetings. On Feb. 20, the Kansas City Star ran “Republicans are walking into Democrats’ Obamacare swamp” by columnist Dave Helling, who writes: “By repealing and replacing, Republicans will own the American health care system for the next four years.”

GOP members of Congress should read Helling’s short op-ed. And besides the warning that Republicans will “own” America’s healthcare if they’re not careful, he touches on healthcare pricing. And as if on cue, Fox News’ Tucker Carlson did a segment on Feb. 21, “Health Care Pricing Has Been Rigged,” that featured former hospital executive Steven Weissman:

Mr. Weissman also focused on the issue of pricing at the Daily Caller in January when he wrote on “Healthcare Sticker Shock”:

Both political parties are attacking the problem from the wrong end -- health insurance. Premiums are a direct function of the amounts paid for hospitals, labs, physicians and drugs. The only way to materially reduce insurance premiums and healthcare as a percentage of GDP is to address these underlying healthcare costs.

Weissman believes the American healthcare system is based on predatory pricing. As an example, he reports that tests from the same lab can differ in prices by a factor of 40. It’s interesting that one of the pillars of ObamaCare is the policy of “community rating,” which dictates that everyone will pay the same prices for insurance premiums regardless of any pre-existing conditions. Yet, the pricing done by doctors and hospitals is all over the place. “No congressperson can oppose legitimate pricing or defend our predatory system,” Weissman writes. “The desire for legitimate healthcare pricing is the one… unifying American issue.”

In sum, doctors and hospitals are charging folks whatever they can get. But they might be driven to do that to offset losses they incur from patients on Medicaid and from patients who still, even with ObamaCare, are using emergency rooms. It’s called “cost-shifting,” and it runs a-riot in healthcare. The cure is this: Every item on a medical bill, regardless of whether it’s for major surgery or an aspirin, must have a set price that is the same for all payers, regardless of whether the payer is the government, an insurance company, or an individual paying out-of-pocket.

That requirement might seem like common sense, a no-brainer, eminently fair, and quintessentially American, but it’s not the case with our healthcare. And if such a requirement were implemented, it would present a big problem for government systems like Medicaid. At CPAC on Feb. 24, the president said:

I tell them from a purely political standpoint, the single-best thing we can do is nothing. Let it implode completely -- it’s already imploding. You see the carriers are all leaving. I mean, it’s a disaster.

But two years don’t do anything. The Democrats will come to us and beg for help. They’ll beg, and it’s their problem. But it’s not the right thing to do for the American people. It’s not the right thing to do.

President Trump is right: we need to repeal ObamaCare, not let it die on its own. And the GOP needs to know that if they don’t repeal ObamaCare, they will “own” ObamaCare. They will be pilloried and “primaried” out of office if they renege on their promise to repeal the ACA.

Until and unless they can correct healthcare pricing, Republicans shouldn’t even dream of “replacing” ObamaCare -- they should repeal only.

That means resetting America’s healthcare and health insurance back to what it was before the Pelosi-Reid-Obama axis got their hands on it; it means going back to the way things were just three years ago when ObamaCare became operational. But after repeal, when they’re trying to reform healthcare and get the pricing mechanism working correctly, the GOP should avoid the Democrat’s mistake of not seeking bipartisan buy-in. In the spirit of collegiality, Republicans could create a big red reset button and invite Democrats to punch it with them. They might even let the Dems hold the button for the photo-op.

Jon N. Hall of Ultracon Opinion is a programmer/analyst from Kansas City. 

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