What a week it’s been. I am not sure why President Trump thinks that his latest attempt to coerce the Republican Congress will work better than his past efforts. The Democrats relied on 50 votes to get the Affordable Care Act (ACA) through and now the Republicans are trying to rely on 50 votes to make their mark. The Congressional Budget Office scoring on repeal and replace was a disaster. And it doesn’t take a lot of reflection to realize that there is no turning back on some of the ACA changes – for example, guaranteed issue and Medicaid expansion – which the states are going to have a hard time backpedaling on politically. With reality setting in perhaps we can now collectively agree that we need bipartisan commitment to fix healthcare.
Here are some thoughts:
- Increase the individual penalty so that the free riders get hurt if they aren’t in the system. Medicare does this very effectively and can be a model.
- Increase rating bands from three to five. 27-year-olds simply can’t afford to subsidize older Americans to the extent that we have asked them to do so.
- Create a federal system to backstop high cost claimants. The luck of the draw should be spread evenly, not just to the risk pools where they fall.
- Rein in pharmacy inflation and mandate transparency.
- Can we do something about tort reform?
There’s a start. Hopefully it will get some traction.