Repealing Obamacare an open door to Medicare reform

The Obamacare repeal and replace is causing more than a little angst among some conservatives, who complain of many deficiencies in the bill.  There may be a hidden treasure in this piece of legislation, however.  It appears that Paul Ryan and friends finally have a vehicle for Medicare reform. 

Before we get to that, let's review some of the criticisms of the proposal.  None of the various missing pieces in the initial phase of the bill should come as a surprise, or be a source of alarm to the opponents.   

Critics are concerned that many Obamacare regulations remain.  The power to establish these regulations and therefore the power to roll them back are by law at the discretion of  the Health and Human Services secretary.  Does anyone doubt that Tom Price will roll regulations back?  I mean, really?  

Critics complain that the proposal doesn't allow for the purchase of policies across state lines.  The explanation given by both Speaker Ryan and President Trump is that this provision is not appropriate for an appropriations bill that can pass by reconciliation – that is, a bill that requires only 51 votes. 

President Trump said – well, he tweeted, which is even better – that this provision will be in phase II or phase III of the rollout.  This leads the critics to ask: how do we know that additional phases will ever happen?  Right after building the wall, Trump's next big campaign promise was to erase the (state) lines that prevent a national health insurance market.  Trump rode that horse so hard that Marco Rubio got on his one major roll by insisting that this was Trump's only mount.  With that in mind, the critics think Trump will just walk away from this promise?  Oh, and they think Speaker Ryan and the rest of the Republican caucus don't care about this issue.  They're kidding, right?

There are other grumbles about the timing of ending this or that piece of Obamacare.  One of the problems with starting any government program is the difficulty of ending it.  It isn't easy to turn off the spigot, because real people become dependent on the flow.  There are two lessons here: 1. Programs are necessarily wound down gradually, and 2. never again give the Democrats the power to create another new program.  As bad as Obamacare is, Democrats are capable of worse. 

The big concern for critics is the refundable tax credit, which balances the tax advantage that employer-provided insurance plans have over individual policies.  Another effect of these credits makes it possible for poorer people to buy health insurance in the market.  This is referred to as Obamacare Lite and is rejected, as a matter of principle, by some members in the Republican coalition.  

One defense of tax credits involves what we now call the "optics" of throwing people out of policies they now enjoy.  That's a practical political concern, which the purest reject as a sellout.  If the purists act out as they did in 2006, we'll get another super-Democrat majority, and this time, the result will be a single-payer system.  Really!

Here is an obvious defense.  Providing this level of medical insurance coverage was a plank in the platform of the Republican candidate for president.  I think his name was Trump.  Elections have consequences.  Here is a consequence that only the most die-hard NeverTrumps can complain about.  The rest of us are complicit and have little ground for complaints.  

But we don't need to gripe and grumble.  The tax credits are built in partly on need but also on age.  The older one gets, the bigger the credit.  That's easy to understand; the older we get, the more expensive health insurance gets.  That's why Medicare was passed.  The problem is, Medicare is a financial house of cards.  If nothing is done, Medicare will bankrupt the country.  

It occurs to me, and, I suspect, to Speaker Ryan, that it would be a golden idea to structure an insurance environment that allows and encourages people to buy their own plans even in their golden years.  Some people remain quite healthy even as they age.  Others are not so lucky, or not so lucky in that way.  People could buy what they need.  What a concept!

If we use this framework of the repeal and replace package, we could free our elderly from what is for them a single-payer system.  The Democrats are constantly trying to cut Medicare to avoid its financial collapse.

Having an actual insurance system for the elderly would remove that sword of Damocles.  As we age, we have enough to worry about, without fretting that another Obama will be elected. 

When  it comes to entitlement reform, there are only a few Republicans, and at this moment, no – that's nada, zip, zero – Democrats willing to act like adults.  It looks as though Speaker Ryan and most of the House Republicans are acting like very creative adults.  I think it's only fair to ask their critics to be equally mature.  If they calm down, they might discover a treasure right at their feet.

The Obamacare repeal and replace is causing more than a little angst among some conservatives, who complain of many deficiencies in the bill.  There may be a hidden treasure in this piece of legislation, however.  It appears that Paul Ryan and friends finally have a vehicle for Medicare reform. 

Before we get to that, let's review some of the criticisms of the proposal.  None of the various missing pieces in the initial phase of the bill should come as a surprise, or be a source of alarm to the opponents.   

Critics are concerned that many Obamacare regulations remain.  The power to establish these regulations and therefore the power to roll them back are by law at the discretion of  the Health and Human Services secretary.  Does anyone doubt that Tom Price will roll regulations back?  I mean, really?  

Critics complain that the proposal doesn't allow for the purchase of policies across state lines.  The explanation given by both Speaker Ryan and President Trump is that this provision is not appropriate for an appropriations bill that can pass by reconciliation – that is, a bill that requires only 51 votes. 

President Trump said – well, he tweeted, which is even better – that this provision will be in phase II or phase III of the rollout.  This leads the critics to ask: how do we know that additional phases will ever happen?  Right after building the wall, Trump's next big campaign promise was to erase the (state) lines that prevent a national health insurance market.  Trump rode that horse so hard that Marco Rubio got on his one major roll by insisting that this was Trump's only mount.  With that in mind, the critics think Trump will just walk away from this promise?  Oh, and they think Speaker Ryan and the rest of the Republican caucus don't care about this issue.  They're kidding, right?

There are other grumbles about the timing of ending this or that piece of Obamacare.  One of the problems with starting any government program is the difficulty of ending it.  It isn't easy to turn off the spigot, because real people become dependent on the flow.  There are two lessons here: 1. Programs are necessarily wound down gradually, and 2. never again give the Democrats the power to create another new program.  As bad as Obamacare is, Democrats are capable of worse. 

The big concern for critics is the refundable tax credit, which balances the tax advantage that employer-provided insurance plans have over individual policies.  Another effect of these credits makes it possible for poorer people to buy health insurance in the market.  This is referred to as Obamacare Lite and is rejected, as a matter of principle, by some members in the Republican coalition.  

One defense of tax credits involves what we now call the "optics" of throwing people out of policies they now enjoy.  That's a practical political concern, which the purest reject as a sellout.  If the purists act out as they did in 2006, we'll get another super-Democrat majority, and this time, the result will be a single-payer system.  Really!

Here is an obvious defense.  Providing this level of medical insurance coverage was a plank in the platform of the Republican candidate for president.  I think his name was Trump.  Elections have consequences.  Here is a consequence that only the most die-hard NeverTrumps can complain about.  The rest of us are complicit and have little ground for complaints.  

But we don't need to gripe and grumble.  The tax credits are built in partly on need but also on age.  The older one gets, the bigger the credit.  That's easy to understand; the older we get, the more expensive health insurance gets.  That's why Medicare was passed.  The problem is, Medicare is a financial house of cards.  If nothing is done, Medicare will bankrupt the country.  

It occurs to me, and, I suspect, to Speaker Ryan, that it would be a golden idea to structure an insurance environment that allows and encourages people to buy their own plans even in their golden years.  Some people remain quite healthy even as they age.  Others are not so lucky, or not so lucky in that way.  People could buy what they need.  What a concept!

If we use this framework of the repeal and replace package, we could free our elderly from what is for them a single-payer system.  The Democrats are constantly trying to cut Medicare to avoid its financial collapse.

Having an actual insurance system for the elderly would remove that sword of Damocles.  As we age, we have enough to worry about, without fretting that another Obama will be elected. 

When  it comes to entitlement reform, there are only a few Republicans, and at this moment, no – that's nada, zip, zero – Democrats willing to act like adults.  It looks as though Speaker Ryan and most of the House Republicans are acting like very creative adults.  I think it's only fair to ask their critics to be equally mature.  If they calm down, they might discover a treasure right at their feet.

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