Monday, December 2, 2013

Repeal is Still Dead

A few bullet points on health care reform at the start of December...

*The brutal truth of "repeal" is that whatever the politics, every day a flat-out repeal of the ACA becomes more and more nonsensical. The status quo ante no longer exists; changing the law back to how it was in 2009 wouldn't bring back the health care situation that existed then.

*Hey, health care wonks! I've been using this line about how repeal no longer makes policy sense for some time now, but while I'm confident that's correct, I'm certainly not enough of a health care wonk to write up all the details that make a return (via repeal) to 2009 just plain gibberish -- what I called the Humpty-Dumptyness of the situation. Someone want to take a crack at it?

*It's also true, as Brian Beutler says today (and Kevin Drum said last week) that in simple political terms flat-out repeal is less and less plausible every day, with more and more people having insurance through the exchanges.

*All of which is to say that the US health care system has now been (almost) fully Obamacare-ized, and future changes will build on the ACA. That might even had been true after a GOP landslide in 2012, but it's certainly true now.

*Which in turn means that radicals who insist that Republicans who deviate at all from the hard-line repeal message are asking those Republicans to (continue to) absent themselves from the real debate over what's next.

*Of course, that would be less true if there really was a Republican alternative to the ACA -- if "repeal and replace" had ever become a true alternative. But even so, any alternative to Obamacare will, at this point, have to build on Obamacare.

*It also means that all-or-nothing assessments of the ACA (or of are not only inaccurate, but particularly unhelpful because nothing is really at stake in whether the law "succeeds" or "fails." What matters is what current, Obamacare-ized health care does well, does not so well, and does badly, and what new laws/regulations/practices can help where improvements are needed.

(Yes, I did try to come up with an appropriate Humpty Dance title for this one, but alas I couldn't make it work. Partially because I don't mean to imply that post-ACA health care is broken; what I mean, as I hope is clear, is that the status quo ante can't be put back together again. But mostly because I couldn't find the right quote...I could, however, have opened with "Stop whatcha doin' 'cause I'm about to ruin the image and the style that ya used to.")


  1. So I'm going to point out here that in rural regions, there have been farmers/small businessmen who have been buying independent insurance for years as they progress through their 40's and 50's. These people have been paying over a thousand bucks a month for catastrophic health insurance. I know because I'm related to some of them.

    As they enroll in the exchanges and receive subsidies for their health insurance, those premiums will likely drop 50-70%.

    This will provide a small stimulus for rural regions as older people start having an extra $500 - $700 a month to spend on whatever they want.

  2. This will provide a small stimulus for rural regions as older people start having an extra $500 - $700 a month to spend on whatever they want.

    They'll send some non-trivial amount of it to politicians who will have convinced them they've bargained away their precious American freedom for that $500-$700 mess of pottage.

  3. Just grab 'em in the biscuits? :-)

  4. As I pointed out in a comment in another thread, people aren't going to realize that it's the ACA that makes their insurance policy affordable, that it's the ACA that makes their insurance policy actually insure them, that it's the ACA that prevents hospitals from overcharging them.

    If you sign up for Medicare, you know you are signing up for Medicare, so even the Tea Partiers know that they don't want their Medicare taken away. But is just a portal site that points you to an insurance company.

    We bleeding-heart liberals may be being quite naïve about how much credit we will be getting for fixing the horrific problems in US health care delivery. I hope I'm wrong...

  5. You got it down when you appear to be in pain.

    1. Maybe. Can't use "biscuits," since that's a quote from another record. I'm not sure this one is a good enough fit.

  6. Patently rediculous assertion and horribly uneducated. Less people are insured now than prior to ACA. Period. The Invincibles are not signing up and won't. This makes the entire premise moot, even by CBO reports. This will collapse under its own weight. Do we go back to 2009, no. But in the rush for everyone to give Obama a victory, we forgot to look at the other options that were proffered and rejected by the King and his court

    1. I made no assertion about whether ACA is working or would work. It may very well collapse because healthy people don't want insurance. Still seems massively unlikely to me, but it's certainly possible.

      The assertion is that the world has changed so much that just repealing ACA is no longer a plausible option. I believe that's true whether it's a brilliant success or a complete disaster. That's what you need to argue with.


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