March 28, 2017

The recent attempt at passing a healthcare reform bill through the House of Representatives highlights both the widely divergent opinions on the ACA as well as the strong desire among many legislators on both sides to find ways to improve the way healthcare works for many of their constituents. I hope this will be an opportunity to build a coalition for rational healthcare reform that includes strong representation from both sides of the aisle. Could that even be possible? I think the answer to that question depends on where you think our political leaders see public opinion headed. 


Philosophically speaking, the left and right could not be more at odds. The conservative line seems to be that government should have a minimalist role, and that left unhindered, market forces will drive efficiency and quality.  Forcing citizens to pay the government so it can subsidize insurance for the sick and poor is inefficient, and represents a redistribution of wealth more consistent with a socialist state than a democratic one. The left, for its part, sees an appropriately robust role for government in regulating a market characterized by inelastic demand (you can’t just decide not to get your broken arm set), and wants to ensure that every citizen has affordable access to quality care, no matter what the cost – even if that means a multi-trillion dollar Medicare-for-all single payer system.  While both sides have reasonable positions and oppositions in the abstract, in practice the arguments are much more about soundbites and scapegoats than sound economics and the realities of the current healthcare landscape.


It’s too bad, really, because setting aside the ultra-right and ultra-left, there seems to be a lot of common ground today around government providing reasonable rules for plan quality, limited financial aid to help those in need, and for working on ways to keep the cost of quality care down for everyone.  One of the big obstacles here is the assertion that ACA cannot survive. Of course it can, and if the real problem is rising costs and shrinking options in fragile markets, that can be addressed. 


Here is my suggestion: the ACA includes payer risk-remediation programs designed to moderate rates and enhance market choice, and they could still work.  The reason they have not been effective is that ACA opponents blocked their funding in the house and challenged their existence in the courts.  Now we cannot expect anyone who has repeatedly lamented the fact that the ACA is irretrievably broken to admit they had a hand in breaking it, but maybe they can take credit for saving the day.  The AHCA contained provisions for “risk pools,” which is an idea designed to address the same underlying issue – how to pay for folks that cost a lot more than average.  What if the administration was given bi-partisan support to “save” the ACA with the introduction of the innovative risk pool concept, while also quietly dropping litigation to block risk adjustment payments to payers at the same time, all in exchange for some payer concessions like price moderation and pledged support for a few fragile state marketplaces?  ACA opponents could take credit for fixing the broken machine, and we could all enjoy a more stable system where both parties have skin in the game.


It’s hard to get a good healthcare debate among the general population, but I know our followers really know healthcare. Please let us know what you think of this idea and let’s keep the conversation going. Tweet us or comment on our LinkedIn with your thoughts! Who knows, maybe someone in Washington, DC will actually notice.

Blog post written by:
Scott Collins
Author: Scott Collins