Ever have an idea which, at least as you’re thinking about it, seems so right a solution to a problem that you really, really want to somehow get the message to the Powers That Be? That’s me tonight.
(And sometimes when I’m in this mood, I play the “letter to your congressman” game — but it doesn’t work with a very Blue Democrat.)
But I’ve come to the conclusion that Republicans are approaching this issue all wrong. Now, for some of them, that’s because they really don’t care. The McCains who pull out the line of “it’s the law; they won and that’s that.” (Was that who it was? Anyway, there are some who either are perfectly happy with O’Care or just don’t care about healthcare in general one way or the other.) And then there are the ones with the approach of “it’s so bad, the only solution is to repeal it altogether.”
But ObamaCare was a monstrosity, a Rube Goldberg sort of legislation — pulling together a mechanism for buying coverage (the exchanges), a set of premium subsidies, a Medicaid expansion, regulations about what must be contained in a health benefits package, taxes which were intended to “fund” it (though everything goes into the same General Revenue pot rather than a separate “ObamaCare” fund), any manner of other demonstration projects and “bend the cost curve” programs, etc.
And maybe this means we stop thinking of it as one single coherent piece of legislation that has to be undone by one single repeal.
So what if the House Republicans start small? What if their first demand, in the current budget negotiations, was to repeal the employer mandate, which, instead of motivating employers to begin offering health insurance, has had the effect of motivating them to reduce their employees’ hours, and which many Dems also agree is a problem?
Then — in baby steps — demand, in the next round of negotiations, demand the restoration of full age and sex-based actuarial pricing, so that 25-year-old men don’t have to be guilted or tricked into subsidizing coverage for their elders (and, let’s face it, for women).
Other baby steps:
- Allow individuals to receive the premium support benefits when shopping outside the “exchange.”
- Allow high deductible/catastrophic plans.
- Equalize tax treatment of employer-sponsored and individually-purchased policies.
- Clean up the subsidy formulas.
- Clean up subsidy eligibility — even liberals have noticed that workers whose employers offer employee-only, rather than family coverage, are currently ineligible for subsidies for their families.
- Fund the subsidies honestly and openly, rather than through hidden taxes.
- Eliminate contraceptive mandates, as well as the other coverage mandates.
- Clean up all the slush funds hidden in the fine print.
- etc.
(The individual mandate? No, that should be low priority — and it could easily be swapped out for a tax credit with the same effect — money that you lose out on without insurance.)
Unfortunately, this requires legislators serious about fixing the health care system, such as it is, rather than scoring political points. But I can dream, can’t I?
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