Robert Laszewski is analyzing the recent Republican “plan” to replace Obamacare with Hatch/Burr/Upton. I analyzed the basic projection last year in three parts (Part 1, Part 2, Part 3). The basic analysis is that Hatch/Burr/Coburn assumed that the big problem with the US healthcare system is that us peons have it too good as it is now, and the actuarial value of our coverage is way too high. Low value coverage would be provided with small tax credits, and then everything else would allow the invisible hand of the free market to fist us.
There are a couple of things worth talking about (Medicaid demonstration waivers, price transparency etc) on purely technocratic grounds, and then there are a lot of conflicting values being displayed by budgetary committments between Hatch/Burr/Coburn or Upton vs. current baseline of PPACA.
Laszewski makes a decent point with the following:
They will have an uphill battle. Not because these Republicans don’t have a lot of good ideas, but because they have put a list of big and complicated changes on the table. Lots of people may not like Obamacare but Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause….
Status quo bias is immensely strong in healthcare politics as Democrats have been getting kicked in the groin on status quo changes for the past three election cycles. However he goes off the rails when he says the public would like a bit of PPACA and a bit of Hatch/Burr/Upton but there is one big block to that:
If Democrats would just admit Obamacare needs some pretty big fixes, and Republicans would be willing to work on making those fixes by putting some of these good ideas on the table, the American people would be a lot better off
Democrats have been offering fixes, tweaks and changes to PPACA since the ink dried on Obama’s signature in March, 2010. Just in 2013/ 2014, there was a proposal to add a Copper plan level, there was a proposal to tweak ministry plans, there was a proposal to delay the sunsetting of non-compliant plans, there was a proposal to tweak expatriate coverage, Democrats have been proposing numerous fixes, tweaks and modifications to a basic structure of a guarantee issue, subsidized, mandated insurance tripod. Right now the Republican response has been fuck you, let’s revert to status-quo of the Bush Administration.
There has been no serious Republican thinking that meets the following two criteria: Does not reduce the current level of coverage for Americans and has at least 10 sponsors or champions in the GOP caucus. One side wants to engage in healthcare policy and the other does not.