Wednesday, January 18, 2017

Can Trump, the GOP, and the country all win with this replacement idea?

Here’s how Donald Trump could replace Obamacare without courting disaster, Ezra Klein (Vox) reports ( h/t Lise Hicks).

Republicans have a problem: The promises they’ve made about what their Obamacare replacement plan will do are impossible to keep.

Over the weekend, Donald Trump told the Washington Post that his plan would provide “insurance for everybody” with “much lower deductibles.” Oh, and don’t worry about the cost. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it,” he said. “That’s not going to happen with us.”

There is simply no way, within the GOP paradigm of private insurance, lower taxes, and less regulation, to make that work. But perhaps he doesn’t need to.

Rep. Tom Price (R-GA) is Trump’s pick to run Health and Human Services. And back in 2006, he was the co-author of a health care plan that could offer Republicans a way out. …

In 2006, Price partnered with Tammy Baldwin, a liberal House Democrat who has since joined the Senate, to release H.R. 5864, “The Health Care Partnership Through Creative Federalism Act.” The bill asked states to submit health reform proposals that would lead to “increased health coverage and access.” Those proposals would be sent to a bipartisan commission for evaluation and certification. If the commission agreed that the proposal was likely to lead to better health care and more coverage, it would be sent to Congress for fast-track consideration. Funding would be provided through some combination of repurposing existing federal money and adding in new grants. The proposals would then be closely studied so other states could learn from their success or failure.

Here’s how Klein sees the benefits to all parties.

The upside for Republicans would be threefold. First, they could say they had replaced Obamacare without actually owning the hard — perhaps even impossible — choices necessary to replace Obamacare. Second, they could say they did it in a way that accorded with Republican principles — by handing the power over to the states rather than dictating a single solution from Washington. Third, it would be states, not the Trump administration, who were responsible for whatever went wrong, or whichever conditions went unfilled.

The upside for the country would be a blossoming of health policy experimentation. Rural states could design a health program that’s a better fit for rural needs. Maryland could expand their all-payer rate setting into a model for the rest of the country. Indiana could take Mike Pence’s Medicaid reforms and use them as a blueprint for a whole new system. California is more than big enough to make a single-payer system work, if it so chose. Texas is more than big enough to make a consumer-driven system work, if it so chose. Perhaps some state, somewhere, comes up with something truly fantastic, and 10 years later, half the country has adopted it.

Of course, the devil is in the details - which you can learn about in Klein’s article. Perhaps the big stumbling block lies in suspicions about what the Republicans’ real aims are.

The premise of a proposal like this is that Republicans want to repeal Obamacare and replace it with a better health care system, and the main challenge is the difficulty of doing so. That’s not obviously the case — it may be that Republicans just want to repeal Obamacare and replace it with lower taxes, or to repeal Obamacare and replace it with less subsidized insurance. That would be deadly for this kind of plan. There is no magic that allows states to do more with less.

And that brings us back to the fundamental question #1: is health care is a right or a privilege? The next question #2 is how Republicans answer #1.

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